1
|
Murray LJ, Appelt AL, Ajithkumar T, Bedford JL, Burnet NG, Lalondrelle S, Manolopoulos S, O'Cathail SM, Robinson M, Short SC, Slevin F, Thomson DJ. Re-irradiation: From Cell Lines to Patients, Filling the (Science) Gap in the Market. Clin Oncol (R Coll Radiol) 2023; 35:318-322. [PMID: 36842937 DOI: 10.1016/j.clon.2023.01.023] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Affiliation(s)
- L J Murray
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - A L Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - T Ajithkumar
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J L Bedford
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - N G Burnet
- The Christie NHS Foundation Trust, Manchester, UK
| | - S Lalondrelle
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital, Sutton, UK
| | - S Manolopoulos
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
| | - S M O'Cathail
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - M Robinson
- Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - S C Short
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - F Slevin
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D J Thomson
- The Christie NHS Foundation Trust, Manchester, UK; The University of Liverpool, Liverpool, UK
| |
Collapse
|
2
|
Iyizoba-Ebozue Z, Murray LJ, Ramasamy S, Sen M, Murray P, Cardale K, Dyker K, Prestwich RJD. Radiotherapy for Oropharyngeal Carcinoma With an Uninvolved Contralateral Neck: The Safety of Omission of Contralateral High Level II and Retropharyngeal Lymph Nodes From Elective Target Volumes. Clin Oncol (R Coll Radiol) 2020; 33:331-339. [PMID: 33358282 DOI: 10.1016/j.clon.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/05/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022]
Abstract
AIMS To analyse outcomes and patterns of failure in patients with oropharyngeal carcinoma (OPC) treated with definitive volumetric modulated arc therapy with omission of contralateral high level II lymph nodes (HLII) and retropharyngeal lymph nodes (RPLN) in the contralateral uninvolved neck. MATERIALS AND METHODS Patients with OPC treated between January 2016 and July 2019 were retrospectively identified. In the absence of contralateral neck disease, institutional protocols allowed omission of contralateral HLII and contralateral RPLN in the additional absence of ipsilateral RPLN, soft palate/posterior pharyngeal wall primary. RESULTS In total, 238 patients with OPC and an uninvolved contralateral neck received definitive (chemo)radiotherapy with bilateral neck treatment. The median follow-up was 30.6 months. Two-year local control, regional control and overall survival were 91.0, 91.6 and 86.5%, respectively. Contralateral HLII were omitted in 159/238 (66.8%) patients; this included 106 patients in whom the primary tumour was at/crossed the midline. The contralateral RPLN region was omitted from elective target volumes for 175/238 (73.5%); this included 114 patients with a primary tumour at/crossed the midline. The mean contralateral parotid dose when contralateral HLII and RPLN were both omitted was 24.4 Gy, compared with 28.3 Gy without HLII/RPLN omission (P < 0.001). Regional progression occurred in 18/238 (7.6%) patients, all involving the ipsilateral neck with one bilateral. There were no recurrences in the contralateral HLII or RPLN regions. CONCLUSION In patients with OPC and an uninvolved contralateral neck receiving bilateral (chemo)radiotherapy, the omission of contralateral RPLN and HLII from elective target volumes was safe and could lead to reduced contralateral parotid doses.
Collapse
Affiliation(s)
| | - L J Murray
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, UK
| | - S Ramasamy
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - M Sen
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - P Murray
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - K Cardale
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - K Dyker
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - R J D Prestwich
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK.
| |
Collapse
|
3
|
Murray LJ, Lilley J, Hawkins MA, Henry AM, Dickinson P, Sebag-Montefiore D. Pelvic re-irradiation using stereotactic ablative radiotherapy (SABR): A systematic review. Radiother Oncol 2017; 125:213-222. [PMID: 29066125 DOI: 10.1016/j.radonc.2017.09.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/07/2017] [Accepted: 09/19/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE To perform a systematic review regarding the use of stereotactic ablative radiotherapy (SABR) for the re-irradiation of recurrent malignant disease within the pelvis, to guide the clinical implementation of this technique. MATERIAL AND METHODS A systematic search strategy was adopted using the MEDLINE, EMBASE and Cochrane Library databases. RESULTS 195 articles were identified, of which 17 were appropriate for inclusion. Studies were small and data largely retrospective. In total, 205 patients are reported to have received pelvic SABR re-irradiation. Dose and fractionation schedules and re-irradiated volumes are highly variable. Little information is provided regarding organ at risk constraints adopted in the re-irradiation setting. Treatment appears well-tolerated overall, with nine grade 3 and six grade 4 toxicities amongst thirteen re-irradiated patients. Local control at one year ranged from 51% to 100%. Symptomatic improvements were also noted. CONCLUSIONS For previously irradiated patients with recurrent pelvic disease, SABR re-irradiation could be a feasible intervention for those who otherwise have limited options. Evidence to support this technique is limited but shows initial promise. Based on the available literature, suggestions for a more formal SABR re-irradiation pathway are proposed. Prospective studies and a multidisciplinary approach are required to optimise future treatment.
Collapse
Affiliation(s)
- Louise Janet Murray
- Radiotherapy Research Group, Leeds Institute of Cancer and Pathology, University of Leeds, UK; Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, UK.
| | - John Lilley
- Department of Medical Physics, Leeds Cancer Centre, St James's University Hospitals, UK
| | - Maria A Hawkins
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, UK
| | - Ann M Henry
- Radiotherapy Research Group, Leeds Institute of Cancer and Pathology, University of Leeds, UK; Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, UK
| | - Peter Dickinson
- Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, UK
| | - David Sebag-Montefiore
- Radiotherapy Research Group, Leeds Institute of Cancer and Pathology, University of Leeds, UK; Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, UK
| |
Collapse
|
4
|
Cook MB, Wood S, Hyland PL, Caron P, Drahos J, Falk RT, Pfeiffer RM, Dawsey SM, Abnet CC, Taylor PR, Guillemette C, Murray LJ, Anderson LA. Sex steroid hormones in relation to Barrett's esophagus: an analysis of the FINBAR Study. Andrology 2017; 5:240-247. [PMID: 28241109 DOI: 10.1111/andr.12314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 06/09/2016] [Revised: 10/25/2016] [Accepted: 11/16/2016] [Indexed: 12/16/2022]
Abstract
Previously, we observed strong positive associations between circulating concentrations of free testosterone and free dihydrotestosterone (DHT) in relation to Barrett's esophagus in a US male military population. To replicate these findings, we conducted a second study of sex steroid hormones and Barrett's esophagus in the Factors Influencing the Barrett/Adenocarcinoma Relationship (FINBAR) Study based in Northern Ireland and Ireland. We used mass spectrometry to quantitate EDTA plasma concentrations of nine sex steroid hormones and ELISA to quantitate sex hormone-binding globulin in 177 male Barrett's esophagus cases and 185 male general population controls within the FINBAR Study. Free testosterone, free DHT, and free estradiol were estimated using standard formulas. Multivariable logistic regression estimated odds ratios (OR) and 95% confidence intervals (95%CI) of associations between exposures and Barrett's esophagus. While plasma hormone and sex hormone-binding globulin concentrations were not associated with all cases of Barrett's esophagus, we did observe positive associations with estrogens in younger men (e.g. estrone + estradiol ORcontinuous per ½IQR = 2.92, 95%CI:1.08, 7.89), and free androgens in men with higher waist-to-hip ratios (e.g. free testosterone ORcontinuous per ½IQR = 2.71, 95%CI:1.06, 6.92). Stratification by body mass index, antireflux medications, and geographic location did not materially affect the results. This study found evidence for associations between circulating sex steroid hormones and Barrett's esophagus in younger men and men with higher waist-to-hip ratios. Further studies are necessary to elucidate whether sex steroid hormones are consistently associated with esophageal adenocarcinogenesis.
Collapse
Affiliation(s)
- M B Cook
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - S Wood
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - P L Hyland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - P Caron
- Pharmacogenomics Laboratory, Centre Hospitalier de l'Université Laval de Québec (CHU de Québec) Research Center and Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
| | - J Drahos
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - R T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - R M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - S M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - C C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - P R Taylor
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - C Guillemette
- Pharmacogenomics Laboratory, Centre Hospitalier de l'Université Laval de Québec (CHU de Québec) Research Center and Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
| | - L J Murray
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, Northern Ireland
| | - L A Anderson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, Northern Ireland
| |
Collapse
|
5
|
Gray RT, Coleman HG, Lau KW, McCaughey C, Coyle PV, Murray LJ, Johnston BT. Heller's myotomy and pneumatic dilatation in the treatment of achalasia: a population-based case-control study assessing long-term quality of life. Dis Esophagus 2017; 30:1-7. [PMID: 26541271 PMCID: PMC6036654 DOI: 10.1111/dote.12445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Long-term health-related quality-of-life (HRQL) outcomes have not been widely reported in the treatment of achalasia. The aims of this study were to examine long-term disease-specific and general HRQL in achalasia patients using a population-based case-control method, and to assess HRQL between treatment interventions. Manometrically diagnosed achalasia cases (n = 120) were identified and matched with controls (n = 115) using a population-based approach. Participants completed general (SF-12) and disease-specific (Achalasia Severity Questionnaire [ASQ]) HRQL questionnaires, as appropriate, in a structured interview. Mean composite scores for SF-12 (Mental Component Summary score [MCS-12] and Physical Component Summary score [PCS-12]) and ASQ were compared between cases and controls, or between intervention groups, using an independent t-test. Adjusted mean differences in HRQL scores were evaluated using a linear regression model. Achalasia cases were treated with a Heller's myotomy (n = 43), pneumatic dilatation (n = 44), or both modalities (n = 33). The median time from last treatment to HRQL assessment was 5.7 years (interquartile range 2.4-11.5). Comparing achalasia patients with controls, PCS-12 was significantly worse (40.9 vs. 44.2, P = 0.01), but MCS-12 was similar. However, both PCS-12 (39.9 vs. 44.2, P = 0.03) and MCS-12 (46.7 vs. 53.5, P = 0.004) were significantly impaired in those requiring dual treatment compared with controls. Overall however, there was no difference in adjusted HRQL between patients treated with Heller's myotomy, pneumatic dilatation or both treatment modalities. In summary, despite treatment achalasia patients have significantly worse long-term physical HRQL compared with population controls. No HRQL differences were observed between the treatment modalities to suggest a benefit of one treatment over another.
Collapse
Affiliation(s)
- R T Gray
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Northern Ireland, UK
| | - H G Coleman
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Northern Ireland, UK
| | - K W Lau
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Northern Ireland, UK
| | - C McCaughey
- Regional Virus Laboratory, Kelvin Building, Belfast Health and Social Care Trust, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - P V Coyle
- Regional Virus Laboratory, Kelvin Building, Belfast Health and Social Care Trust, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - L J Murray
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Northern Ireland, UK
| | - B T Johnston
- Department of Gastroenterology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| |
Collapse
|
6
|
Murray LJ, Hawkins C, Taylor M, Bartels UK, Huang A, Kulkarni A, Ramaswamy V, Bouffet E, Tabori U, Laperriere N. Re-irradiation for relapsed paediatric ependymoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10565] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Annie Huang
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Eric Bouffet
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Uri Tabori
- The Hospital for Sick Children, Toronto, ON, Canada
| | | |
Collapse
|
7
|
O'Rorke MA, Murray LJ, Brand JS, Bhoo-Pathy N. The value of adjuvant radiotherapy on survival and recurrence in triple-negative breast cancer: A systematic review and meta-analysis of 5507 patients. Cancer Treat Rev 2016; 47:12-21. [PMID: 27214603 DOI: 10.1016/j.ctrv.2016.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 03/21/2016] [Revised: 04/26/2016] [Accepted: 05/04/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The value of adjuvant radiotherapy in triple negative breast cancer (TNBC) remains unclear. A systematic review and meta-analysis was conducted in TNBC patients to assess survival and recurrence outcomes associated with radiotherapy following either breast conserving therapy (BCT) or post-mastectomy radiotherapy (PMRT). METHODS Four electronic databases were searched from January 2000 to November 2015 (PubMed, MEDLINE, EMBASE and Web of Science). Studies investigating overall survival and/or recurrence in TNBC patients according to radiotherapy administration were included. A random effects meta-analysis was conducted using mastectomy only patients as the reference. RESULTS Twelve studies were included. The pooled hazard ratio (HR) for locoregional recurrence comparing BCT and PMRT to mastectomy only was 0.61 (95% confidence interval [CI] 0.41-0.90) and 0.62 (95% CI 0.44-0.86), respectively. Adjuvant radiotherapy was not significantly associated with distant recurrence. The pooled HR for overall survival comparing BCT and PMRT to mastectomy only was 0.57 (95% CI 0.36-0.88) and HR 1.12 (95% CI 0.75, 1.69). Comparing PMRT to mastectomy only, tests for interaction were not significant for stage (p=0.98) or age at diagnosis (p=0.85). However, overall survival was improved in patients with late-stage disease (T3-4, N2-3) pooled HR 0.53 (95% CI 0.32-0.86), and women <40years, pooled HR 0.30 (95% CI 0.11-0.82). CONCLUSIONS Adjuvant radiotherapy was associated with a significantly lower risk of locoregional recurrence in TNBC patients, irrespective of the type of surgery. While radiotherapy was not consistently associated with an overall survival gain, benefits may be obtained in women with late-stage disease and younger patients.
Collapse
Affiliation(s)
- M A O'Rorke
- Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital Site, Grosvenor Road, Belfast BT12 6BJ, United Kingdom.
| | - L J Murray
- Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital Site, Grosvenor Road, Belfast BT12 6BJ, United Kingdom
| | - J S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17177 Stockholm, Sweden
| | - N Bhoo-Pathy
- Julius Centre University of Malaya (JCUM), Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
| |
Collapse
|
8
|
O'Rorke MA, Murray LJ, Bhoo Pathy N. Abstract P3-12-10: Overall survival in triple-negative breast cancers - Prognostic influence of type of surgery and adjuvant radiotherapy: A systematic review and meta-analysis. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-12-10] [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: 11/16/2022]
Abstract
Abstract
BACKGROUND: Triple negative breast cancers (TNBC) are an aggressive, poorer prognostic tumour subtype which are negative for oestrogen, progesterone and human epidermal growth factor receptor 2 (HER-2) expression. Whilst the role of radiotherapy (RT) following breast conserving therapy (BCT) is widely accepted, there is no agreed consensus on the use of post-mastectomy RT, particularly in early-stage TNBC patients.
METHODS: Four electronic databases were searched from their inception to April 2015 including PubMed, MEDLINE, EMBASE and web of science. Observational studies investigating overall survival and locoregional/distant recurrence outcomes in women with TNBC according to type of surgery and radiotherapy receipt were included. Authors were contacted directly for further data. A random effects model was used to pool study effect estimates using mastectomy (MT) only patients as the reference group.
RESULTS: 8 studies including data from 3,456 patients were included. The median age and duration of follow-up was 54 years and 3.6 years respectively. The adjusted pooled hazard ratio (HR) and 95% confidence interval (CI) for overall survival comparing BCT and MT+RT to MT only was 0.52 (95% CI 0.31, 0.87; I2= 70.9%) and HR 0.60 (95% CI 0.38, 0.96; I2=41.5%) respectively. In subgroup analysis of MT+RT vs. MT alone, there was no significant interaction with early (T1-2, N0-1) vs. late stage (T3-4, N2-3) disease p=0.773 or age at diagnosis (<40, 40-64, ≥65 years) p=0.320. 5 studies evaluated local regional recurrence. Comparing BCT and MT+RT to MT only, the pooled HR was 0.61 (95% CI 0.41, 0.92) and HR 0.83 (95% CI 0.55, 1.26) respectively, with low heterogeneity detected (I2 0.0%). 4 studies assessed distant metastases. The pooled HR comparing BCT and MT+RT to MT only was 0.88 (95% CI 0.62, 1.23; I2= 0.0%) and HR 1.95 (95% CI 0.85, 4.49; I2= 75.1%) respectively.
CONCLUSIONS: The addition of adjuvant radiotherapy appears to favourably impact overall survival, irrespective of the type of surgery received. BCT may reduce the risk of locoregional recurrence in comparison to MT only. The small number of contributing studies and often high study heterogeneity suggest cautious interpretation of the findings. Further epidemiological studies or pooled analyses of individual patient data are warranted.
Citation Format: O'Rorke MA, Murray LJ, Bhoo Pathy N. Overall survival in triple-negative breast cancers - Prognostic influence of type of surgery and adjuvant radiotherapy: A systematic review and meta-analysis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-12-10.
Collapse
Affiliation(s)
- MA O'Rorke
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom; Julius Centre University Of Malaya, Kuala Lumpur, Lembah Pantai, Malaysia
| | - LJ Murray
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom; Julius Centre University Of Malaya, Kuala Lumpur, Lembah Pantai, Malaysia
| | - N Bhoo Pathy
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom; Julius Centre University Of Malaya, Kuala Lumpur, Lembah Pantai, Malaysia
| |
Collapse
|
9
|
McCourt C, Coleman HG, Murray LJ, Cantwell MM, Dolan O, Powe DG, Cardwell CR. Beta-blocker usage after malignant melanoma diagnosis and survival: a population-based nested case-control study. Br J Dermatol 2015; 170:930-8. [PMID: 24593055 DOI: 10.1111/bjd.12894] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Beta-blockers have potential antiangiogenic and antimigratory activity. Studies have demonstrated a survival benefit in patients with malignant melanoma treated with beta-blockers. OBJECTIVES To investigate the association between postdiagnostic beta-blocker usage and risk of melanoma-specific mortality in a population-based cohort of patients with malignant melanoma. METHODS Patients with incident malignant melanoma diagnosed between 1998 and 2010 were identified within the U.K. Clinical Practice Research Datalink and confirmed using cancer registry data. Patients with malignant melanoma with a melanoma-specific death (cases) recorded by the Office of National Statistics were matched on year of diagnosis, age and sex to four malignant melanoma controls (who lived at least as long after diagnosis as their matched case). A nested case-control approach was used to investigate the association between postdiagnostic beta-blocker usage and melanoma-specific death and all-cause mortality. Conditional logistic regression was applied to generate odds ratios (ORs) and 95% confidence intervals (CIs) for beta-blocker use determined from general practitioner prescribing. RESULTS Beta-blocker medications were prescribed after malignant melanoma diagnosis to 20·2% of 242 patients who died from malignant melanoma (cases) and 20·3% of 886 matched controls. Consequently, there was no association between beta-blocker use postdiagnosis and cancer-specific death (OR 0·99, 95% CI 0·68-1·42), which did not markedly alter after adjustment for confounders including stage (OR 0·87, 95% CI 0·56-1·34). No significant associations were detected for individual beta-blocker types, by defined daily doses of use or for all-cause mortality. CONCLUSIONS Contrary to some previous studies, beta-blocker use after malignant melanoma diagnosis was not associated with reduced risk of death from melanoma in this U.K. population-based study.
Collapse
Affiliation(s)
- C McCourt
- Department of Dermatology, Belfast Health and Social Care Trust, Belfast, Northern Ireland; Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Institute of Clinical Sciences-B, Royal Victoria Hospital Site, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland
| | | | | | | | | | | | | |
Collapse
|
10
|
Neville CE, McKinley MC, Murray LJ, Boreham CA, Woodside JV. Fruit and vegetable consumption and muscle strength and power during adolescence: a cross-sectional analysis of the Northern Ireland Young Hearts Project 1999-2001. J Musculoskelet Neuronal Interact 2014; 14:367-376. [PMID: 25198233] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To examine the association between fruit and vegetable (FV) consumption and muscle strength and power in an adolescent population. METHODS We conducted a cross-sectional analysis among 1019 boys and 998 girls, aged 12 and 15 years, who participated in The Young Hearts Project. FV consumption (excluding potatoes) was assessed by 7-d diet history. Grip strength and jump power was assessed with a dynamometer and Jump-MD meter, respectively. Associations between FV consumption and strength and power were assessed by regression modelling. RESULTS Boys and girls with the highest FV intakes (>237.71 g/d and >267.57 g/d, respectively, based on the highest tertile) had significantly higher jump power than those with the lowest intakes (<135.09 g/d and <147.43 g/d, respectively), after adjustment for confounding factors. Although girls with the highest FV intakes had higher grip strength than those with the lowest intakes, no significant independent associations were evident between FV intake and grip strength in boys or girls. Similar findings were observed when FV were analysed separately. CONCLUSIONS Higher FV consumption in this group of adolescents was positively associated with muscle power. There was no independent association between higher FV consumption and muscle strength. Intervention studies are required to determine whether muscle strength and power can be improved through increased FV consumption.
Collapse
Affiliation(s)
- C E Neville
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, United Kingdom (CEN, LJM, MCMcK, JVW); University College Dublin, Belfield, Dublin 4, Ireland (CAB)
| | | | | | | | | |
Collapse
|
11
|
Hicks BM, Murray LJ, Powe DG, Hughes CM, Cardwell CR. β-Blocker usage and colorectal cancer mortality: a nested case-control study in the UK Clinical Practice Research Datalink cohort. Ann Oncol 2013; 24:3100-6. [PMID: 24050955 DOI: 10.1093/annonc/mdt381] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Epidemiological and laboratory studies suggest that β-blockers may reduce cancer progression in various cancer sites. The aim of this study was to conduct the first epidemiological investigation of the effect of post-diagnostic β-blocker usage on colorectal cancer-specific mortality in a large population-based colorectal cancer patient cohort. PATIENTS AND METHODS A nested case-control analysis was conducted within a cohort of 4794 colorectal cancer patients diagnosed between 1998 and 2007. Patients were identified from the UK Clinical Practice Research Datalink and confirmed using cancer registry data. Patients with a colorectal cancer- specific death (data from the Office of National Statistics death registration system) were matched to five controls. Conditional logistic regression was applied to calculate odds ratios (OR) and 95% confidence intervals (95% CIs) according to β-blocker usage (data from GP-prescribing records). RESULTS Post-diagnostic β-blocker use was identified in 21.4% of 1559 colorectal cancer-specific deaths and 23.7% of their 7531 matched controls, with little evidence of an association (OR = 0.89 95% CI 0.78-1.02). Similar associations were found when analysing drug frequency, β-blocker type or specific drugs such as propranolol. There was some evidence of a weak reduction in all-cause mortality in β-blocker users (adjusted OR = 0.88; 95% CI 0.77-1.00; P = 0.04) which was in part due to the marked effect of atenolol on cardiovascular mortality (adjusted OR = 0.62; 95% CI 0.40-0.97; P = 0.04). CONCLUSIONS In this novel, large UK population-based cohort of colorectal cancer patients, there was no evidence of an association between post-diagnostic β-blocker use and colorectal cancer-specific mortality. CLINICAL TRIALS NUMBER NCT00888797.
Collapse
Affiliation(s)
- B M Hicks
- Centre for Public Health, Queen's University Belfast, Belfast, Northern, Ireland
| | | | | | | | | |
Collapse
|
12
|
Wilson JC, O'Rorke MA, Cooper JA, Murray LJ, Hughes CM, Gormley GJ, Anderson LA. Non-steroidal anti-inflammatory drug use and cervical cancer risk: a case-control study using the Clinical Practice Research Datalink. Cancer Epidemiol 2013; 37:897-904. [PMID: 24042024 DOI: 10.1016/j.canep.2013.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 01/12/2023]
Abstract
PURPOSE Non-steroidal anti-inflammatory drugs (NSAIDs) have many anticarcinogenic properties via the inhibition of cyclooxygenase 2 (COX-2). Only one study, a cohort study examining risk of all cancers, investigated their role in cervical cancer with inconsistent findings between non-aspirin NSAIDs and aspirin. The aim of this study was to further investigate NSAID/aspirin use and cervical cancer risk. METHODS Using the United Kingdom Clinical Practice Research Datalink, 724 women diagnosed with cervical cancer between 1 January, 1995 and December 2010 were compared to 3479 women (without cervical cancer) matched on year of birth and general practice. Conditional logistic regression analysis adjusted for smoking, sexually transmitted infections, HRT and contraceptive use, was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for cervical cancer risk among users of any oral NSAIDs, non-aspirin NSAIDs and aspirin, as assessed from primary care prescribing data. RESULTS Excluding the year prior to diagnosis, there was no association in adjusted analyses between ever vs. never use of an NSAID (OR 0.92, 95% CI 0.77-1.09), non-aspirin NSAID (OR 0.95, 95% CI 0.80-1.13) or low-dose aspirin (OR 1.07, 0.80-1.44) and cervical cancer risk. In analysis of daily defined doses, there was no association with cervical cancer risk comparing the highest users to non-users of NSAIDs (OR 0.98, 95% CI 0.69-1.39) or non-aspirin NSAIDs (OR 1.00, 95% CI 0.70-1.43) or low-dose aspirin (OR 1.04, 95% CI 0.59-1.81). CONCLUSION This large historical cohort study found no evidence of an association between non-aspirin NSAID or aspirin use and cervical cancer risk.
Collapse
Affiliation(s)
- J C Wilson
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, UK
| | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
BACKGROUND Cancer cachexia is a devastating syndrome of advanced malignancy which negatively impacts on patients' morbidity, mortality and quality of life. Chronic inflammation is a key characteristic of cancer cachexia. Therefore, non-steroidal anti-inflammatory drugs (NSAIDs) may be able to break the cycle of cachexia. AIM To systematically review the literature on the use of NSAIDs for the treatment of cachexia in advanced cancer patients. DESIGN All titles retrieved through searching were downloaded to a reference management database, duplicates were removed and the remaining citations were checked for eligibility. Full copies of all eligible articles were obtained and reviewed. DATA SOURCES Electronic searches (from inception up to 09/2011) included CINAHL, MEDLINE, EMBASE, and Web of Science. Reference lists from reviewed articles, trial registers and abstracts from relevant conferences were searched. Eligibility criteria were (a) Randomised Controlled Trial; (b) participants were adults with cancer with weight loss or a clinical diagnosis of cachexia; (c) administration of oral NSAIDs. RESULTS Four studies were included. These studies provided some evidence of positive therapeutic effect on quality of life, performance status, inflammatory markers, weight gain and survival, but there was insufficient evidence demonstrated for their widespread use in practice. CONCLUSIONS Insufficient studies have been performed to allow a conclusion to be formed with regard to the effectiveness of NSAIDs in the treatment of cachexia in advanced cancer. Major challenges in this patient cohort include the lack of uniformity of inclusion criteria across studies and the frailty of the patients recruited.
Collapse
Affiliation(s)
- J Reid
- Nursing and Midwifery Research Unit, School of Nursing and Midwifery, Queen's University Belfast, UK.
| | | | | | | | | |
Collapse
|
14
|
Wilson JC, Murray LJ, Hughes CM, Black A, Anderson LA. Non-steroidal anti-inflammatory drug and aspirin use and the risk of head and neck cancer. Br J Cancer 2013; 108:1178-81. [PMID: 23449358 PMCID: PMC3619083 DOI: 10.1038/bjc.2013.73] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Evidence for non-steroidal anti-inflammatory drugs (NSAIDs) preventing head and neck cancer (HNC) is inconclusive; however, there is some suggestion that aspirin may exert a protective effect. METHODS Using data from the United States National Cancer Institute Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, we examined the association between aspirin and ibuprofen use and HNC. RESULTS Regular aspirin use was associated with a significant 22% reduction in HNC risk. No association was observed with regular ibuprofen use. CONCLUSION Aspirin may have potential as a chemopreventive agent for HNC, but further investigation is warranted.
Collapse
Affiliation(s)
- J C Wilson
- School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Sciences, Queen's University Belfast, Belfast, UK.
| | | | | | | | | |
Collapse
|
15
|
Chang CK, Mulholland HG, Cantwell MM, Anderson LA, Johnston BT, McKnight AJ, Thompson PD, Watson RGP, Murray LJ. Vitamin d receptor gene variants and esophageal adenocarcinoma risk: a population-based case-control study. J Gastrointest Cancer 2013; 43:512-7. [PMID: 21948293 DOI: 10.1007/s12029-011-9322-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Polymorphisms in the vitamin D receptor (VDR) gene may be of etiological importance in determining cancer risk. The aim of this study was to assess the association between common VDR gene polymorphisms and esophageal adenocarcinoma (EAC) risk in an all-Ireland population-based case-control study. METHODS EAC cases and frequency-matched controls by age and gender recruited between March 2002 and December 2004 throughout Ireland were included. Participants were interviewed, and a blood sample collected for DNA extraction. Twenty-seven single nucleotide polymorphisms in the VDR gene were genotyped using Sequenom or TaqMan assays while the poly(A) microsatellite was genotyped by fluorescent fragment analysis. Unconditional logistic regression was applied to assess the association between VDR polymorphisms and EAC risk. RESULTS A total of 224 cases of EAC and 256 controls were involved in analyses. After adjustment for potential confounders, TT homozygotes at rs2238139 and rs2107301 had significantly reduced risks of EAC compared with CC homozygotes. In contrast, SS alleles of the poly(A) microsatellite had significantly elevated risks of EAC compared with SL/LL alleles. However, following permutation analyses to adjust for multiple comparisons, no significant associations were observed between any VDR gene polymorphism and EAC risk. CONCLUSIONS VDR gene polymorphisms were not significantly associated with EAC development in this Irish population. Confirmation is required from larger studies.
Collapse
|
16
|
McCourt HJ, Hunter SJ, Cardwell CR, Young IS, Murray LJ, Boreham CA, McEneny J, Woodside JV, McKinley MC. Adiponectin multimers, body weight and markers of cardiovascular risk in adolescence: Northern Ireland Young Hearts Project. Int J Obes (Lond) 2013; 37:1247-53. [PMID: 23318722 DOI: 10.1038/ijo.2012.214] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 10/23/2012] [Accepted: 11/28/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND Research examining the relationship between adiponectin (AN) isoforms, body weight and cardiovascular (CV) risk factors is limited, particularly in younger populations. OBJECTIVES To investigate the inter-relationships between AN isoforms and CV risk factors, and their dependence on body weight status, in adolescents. DESIGN Blood samples from 92 obese, 92 overweight and 92 normal weight age- and sex-matched adolescents were analysed for traditional cardiovascular disease (CVD) risk biomarkers and also total, high molecular weight (HMW), medium and low molecular weight (LMW) AN. RESULTS A significant inverse association was observed between total and HMW AN and waist-hip ratio (P=0.015, P=0.006, respectively), triglycerides (P=0.003, P=0.003, respectively) and systolic blood pressure (P=0.012, P=0.024, respectively) and a significant positive association with high-density lipoprotein (P<0.001, P<0.001, respectively) in multi-adjusted analyses. There was no evidence of a relationship between multimeric AN and high-sensitivity C-reactive protein. There was also little evidence of a relationship between LMW AN and CVD risk factors. There was a strong, body mass index (BMI)-independent, association between AN, CVD biomarkers and the hypertriglyceridemic waist phenotype. CONCLUSION Prominent, BMI-independent associations between total and HMW AN, but not LMW AN, and CVD risk factors were already evident in this young population. This research in adolescents supports the contention that AN subfractions may have different biological actions. These associations in apparently healthy adolescents suggest an important role for AN and its subfractions in the pathogenesis of metabolic syndrome traits and indicate that the potential for total or HMW AN to act as early universal biomarkers of CV risk warrants further study.
Collapse
Affiliation(s)
- H J McCourt
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Murray LJ, Din OS, Kumar VS, Dixon LM, Wadsley JC. Palliative radiotherapy in patients with esophageal carcinoma: A retrospective review. Pract Radiat Oncol 2012; 2:257-264. [DOI: 10.1016/j.prro.2011.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/03/2011] [Accepted: 12/17/2011] [Indexed: 10/14/2022]
|
18
|
Adapa RM, Mani V, Murray LJ, Degnan BA, Ercole A, Cadman B, Williams CE, Gupta AK, Wheeler DW. Errors during the preparation of drug infusions: a randomized controlled trial. Br J Anaesth 2012; 109:729-34. [PMID: 22850220 DOI: 10.1093/bja/aes257] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We investigated the extent and frequency of dose errors and treatment delays made as a consequence of preparing drug infusions at the bedside, rather than using pre-filled syringes. METHODS Forty-eight nurses with critical care experience volunteered to take part in this randomized, blinded, controlled study conducted in the simulation centre of an urban hospital. They assisted in the management of a simulated patient with septic shock. Vasopressor infusions were prepared either by diluting concentrated drugs from ampoules or were provided in syringes pre-filled beforehand by an intensive care unit resident. RESULTS The time taken for the infusion to be started and the final concentration of the drugs were measured. We also measured the concentration of infusions prepared by a pharmacist and a pharmaceutical company. Nurses took 156 s to start infusions when using pre-filled syringes compared with 276 s when preparing them de novo, a mean delay of 106 s [95% confidence interval (CI) 73-140 s, P<0.0001]. One infusion prepared from ampoules contained one-fifth of the expected concentration of epinephrine; another contained none at all. Medication errors were 17.0 times less likely when pre-filled syringes were used (95% CI 5.2-55.5), and infusions prepared by pharmacy and industry were significantly more likely to contain the expected concentration (P<0.001 for norepinephrine and P=0.001 for epinephrine). CONCLUSIONS Providing drug infusions in syringes pre-filled by pharmacists or pharmaceutical companies would reduce medication errors and treatment delays, and improve patient safety. However, this approach would have substantial financial implications for healthcare providers, especially in less developed countries.
Collapse
Affiliation(s)
- R M Adapa
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
O'Rorke MA, Ellison MV, Murray LJ, Moran M, James J, Anderson LA. Human papillomavirus related head and neck cancer survival: a systematic review and meta-analysis. Oral Oncol 2012; 48:1191-201. [PMID: 22841677 DOI: 10.1016/j.oraloncology.2012.06.019] [Citation(s) in RCA: 294] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 06/18/2012] [Accepted: 06/29/2012] [Indexed: 01/22/2023]
Abstract
Human Papillomavirus (HPV) related oropharyngeal squamous cell carcinomas (OPSCCs) are reported to have improved prognosis and survival in comparison to other head and neck squamous cell cancers (HNSCCs). This systematic review and meta-analysis examines survival differences in HPV-positive HNSCC and OPSCC subtypes including tonsillar carcinoma in studies not previously investigated. Four electronic databases were searched from their inception till April 2011. A random effects meta-analysis was used to pool study estimates evaluating disease-specific (death from HNSCC), overall (all-cause mortality), progression-free and disease-free (recurrence free) survival outcomes in HPV-positive vs. HPV-negative HNSCCs. All statistical tests were two-sided. Forty-two studies were included. Patients with HPV-positive HNSCC had a 54% better overall survival compared to HPV-negative patients HR 0.46 (95% CI 0.37-0.57); the pooled HR for tonsillar cancer and OPSCC was 0.50 (95% CI 0.33-0.77) and HR 0.47 (95% CI 0.35-0.62) respectively. The pooled HR for disease specific survival was 0.28 (95% CI 0.19-0.40); similar effect sizes were found irrespective of the adjustment for confounders, HPV detection methods or study location. Both progression-free survival and disease-free survival were significantly improved in HPV-positive HNSCCs. HPV-positive HNSCCs and OPSCCs patients have a significantly lower disease specific mortality and are less likely to experience progression or recurrence of their cancer than HPV-negative patients; findings which have connotations for treatment selection in these patients.
Collapse
Affiliation(s)
- M A O'Rorke
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queens University Belfast, Belfast, UK.
| | | | | | | | | | | |
Collapse
|
20
|
Bradley MC, Murray LJ, Cantwell MM, Hughes CM. Proton pump inhibitors and histamine-2-receptor antagonists and pancreatic cancer risk: a nested case-control study. Br J Cancer 2011; 106:233-9. [PMID: 22108522 PMCID: PMC3251858 DOI: 10.1038/bjc.2011.511] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The relationship between use of proton pump inhibitors (PPIs) and histamine-2-receptor antagonists (H(2)RAs) and pancreatic cancer risk has yet to be examined. Data from a range of studies suggest biologically plausible mechanisms, whereby these drugs (or the conditions for which they are prescribed) may affect pancreatic cancer risk. The objective of this study was to investigate the relationship between use of PPIs/H(2)RAs and pancreatic cancer risk. METHODS A nested case-control study was conducted within the UK general practice research database (GPRD). Cases had a diagnosis of exocrine pancreatic cancer and controls were matched to cases on general practice site, sex and year of birth. Exposure to PPIs and to H(2)RAs since entry into GPRD until 2 years before the diagnosis date (corresponding date in controls) and in the 5 years before the diagnosis date were separately assessed. Conditional logistic regression analyses were used to generate odds ratios (ORs) and 95% confidence intervals (CIs) associated with PPI or H(2)RA use compared with nonuse. RESULTS Ever use of PPIs since entry into the GPRD (excluding the 2 years prior to diagnosis) was not associated with risk of pancreatic cancer; OR (95% CI) 1.02 (0.85-1.22). Neither the dose nor the duration of PPI or H(2)RA use was associated with pancreatic cancer risk. No consistent patterns of association were seen when cumulative exposure (dose and duration) to these drugs was examined separately or together. CONCLUSION PPI/H(2)RA use, in a UK population, was not associated with pancreatic cancer risk.
Collapse
Affiliation(s)
- M C Bradley
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, UK.
| | | | | | | |
Collapse
|
21
|
Glover JA, Hughes CM, Cantwell MM, Murray LJ. A systematic review to establish the frequency of cyclooxygenase-2 expression in normal breast epithelium, ductal carcinoma in situ, microinvasive carcinoma of the breast and invasive breast cancer. Br J Cancer 2011; 105:13-7. [PMID: 21654686 PMCID: PMC3137418 DOI: 10.1038/bjc.2011.204] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Epidemiological studies have suggested a protective effect of cyclooxygenase (COX)-inhibiting non-steroidal anti-inflammatory drugs in breast cancer risk and disease progression. We performed a systematic review to evaluate the frequency of COX-2 expression in normal breast epithelium, ductal carcinoma in situ of breast (DCIS), DCIS-adjoining invasive breast cancer, microinvasive carcinoma of the breast (MICB) and invasive breast cancer. Methods: Literature searches were carried out on MEDLINE, EMBASE and Web of Science from their commencement until September 2010. Primary studies examining COX-2 expression by immunohistochemistry methodology were included. Meta-analyses were carried out using random effects models for individual study estimates of COX-2 expression and pooled to give an overall estimate. Results: The pooled prevalences (95% confidence intervals) of COX-2 expressions were 53% (44–61) in DCIS studies and 42% (36–49) in the invasive breast cancer studies. There were too few studies involving normal breast epithelium, DCIS-adjoining invasive breast cancer and MICB to conduct meta-analyses. Conclusion: The findings from our meta-analyses have shown similar COX-2 expression in DCIS and invasive breast cancer. This may suggest the involvement of COX-2 in early carcinogenesis. Further studies of COX-2 expression in DCIS are required to investigate the use of COX-2 as a potential drug target for prevention of disease progression in DCIS.
Collapse
Affiliation(s)
- J A Glover
- Centre for Health Improvement, Queen's University, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science Building, Block B, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.
| | | | | | | |
Collapse
|
22
|
Lane JA, Murray LJ, Harvey IM, Donovan JL, Nair P, Harvey RF. Randomised clinical trial: Helicobacter pylori eradication is associated with a significantly increased body mass index in a placebo-controlled study. Aliment Pharmacol Ther 2011; 33:922-9. [PMID: 21366634 DOI: 10.1111/j.1365-2036.2011.04610.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Body mass index (BMI) increased following Helicobacter pylori eradication in several Japanese cohorts, which requires further investigation. AIM To determine the impact of H. pylori eradication on BMI in a European population. METHODS A total of 10,537 unselected people aged 20-59 years were screened for H. pylori; 1558 of the 1634 infected participants were randomised to intervention (eradication therapy: ranitidine bismuth citrate 400 mg and clarithromycin 500 mg twice daily) or placebo for 2 weeks with follow-up at 6 months (92%) for weight and dyspepsia symptoms (epigastric pain). RESULTS The mean weight of participants in the intervention group increased from 77.7 kg at baseline to 78.4 kg at 6 months (unadjusted increase of 0.7 kg) and from 76.8 to 77.2 kg (0.5 kg) in the placebo group. The adjusted difference between randomised groups was statistically significant at 0.6 kg [95% confidence interval (CI) 0.31, 0.88]. Significantly, more participants gained ≥3 kg in the intervention group (138/720, 19%) compared with the placebo group (92/706, 13%) [odds ratio (OR) 1.57 (95% CI: 1.17, 2.12)]. The mean BMI increased from 27.5 to 27.8 kg/m(2) at 6 months in the intervention group compared with the increase from 27.0 to 27.2 kg/m(2) in the placebo group [adjusted difference between groups was statistically significant at 0.2 kg/m(2) (95% CI: 0.11, 0.31)]. Dyspepsia was less frequently reported by intervention group participants (168/736, 23%, placebo group 209/711, 29%), OR 0.71 (95% CI: 0.55, 0.93). CONCLUSION Body mass index increased significantly following randomisation to H. pylori eradication therapy, possibly due to resolution of dyspepsia.
Collapse
Affiliation(s)
- J A Lane
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, UK.
| | | | | | | | | | | |
Collapse
|
23
|
Murray LJ, Cooper D, Rosenfeld JV, Arabi Y, Davies A, D'urso P, Kossmann T, Ponsford J, Reilly P, Seppelt I, Wolfe R. Optimising the consent process in severe traumatic brain injury trials. Crit Care 2011. [PMCID: PMC3066989 DOI: 10.1186/cc9735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
24
|
Connolly D, van Leeuwen PJ, Bailie J, Black A, Murray LJ, Keane PF, Gavin A. Daily, monthly and seasonal variation in PSA levels and the association with weather parameters. Prostate Cancer Prostatic Dis 2010; 14:58-62. [PMID: 20975738 DOI: 10.1038/pcan.2010.37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PSA levels have shown daily and seasonal variation, although data are conflicting regarding the season with higher PSA levels and the clinical relevance of this. We assessed the correlation of total PSA levels with meteorological data on a daily, weekly, monthly and seasonal basis. Data from 53,224 men aged 45-74 years, with an initial PSA <10.0 ng ml(-1) were correlated with temperature (°C), duration of bright sunshine (hours) and rainfall (mm). There was seasonal variation in PSA levels, with median PSA being higher in spring compared with other seasons (1.18 vs 1.10 ng ml(-1), P = 0.004). Seasonal variation was not apparent when PSA levels were age-adjusted (P = 0.112). Total PSA was not correlated with daily, weekly or monthly hours of sunshine, rainfall or mean temperature. In contrast, age-adjusted PSA varied with weekday, with higher PSA levels on Thursday and Friday compared with other days (1.16 vs 1.10 ng ml(-1), respectively). On multivariate analysis, only age predicted for PSA levels >3.0 ng ml(-1). In conclusion, PSA levels did show seasonal variation, although there was no direct correlation between PSA and any meteorological parameter. The degree of seasonal variation is small and the decision to proceed to prostate biopsy should be independent of season or weather parameters.
Collapse
Affiliation(s)
- D Connolly
- Department of Urology, Belfast City Hospital, Belfast, Northern Ireland, UK.
| | | | | | | | | | | | | |
Collapse
|
25
|
Carsin AE, Drummond FJ, Black A, van Leeuwen PJ, Sharp L, Murray LJ, Connolly D, Egevad L, Boniol M, Autier P, Comber H, Gavin A. Impact of PSA testing and prostatic biopsy on cancer incidence and mortality: comparative study between the Republic of Ireland and Northern Ireland. Cancer Causes Control 2010; 21:1523-31. [PMID: 20514514 DOI: 10.1007/s10552-010-9581-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Accepted: 05/08/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the impact of different PSA testing policies and health-care systems on prostate cancer incidence and mortality in two countries with similar populations, the Republic of Ireland (RoI) and Northern Ireland (NI). METHODS Population-level data on PSA tests, prostate biopsies and prostate cancer cases 1993-2005 and prostate cancer deaths 1979-2006 were compiled. Annual percentage change (APC) was estimated by joinpoint regression. RESULTS Prostate cancer rates were similar in both areas in 1994 but increased rapidly in RoI compared to NI. The PSA testing rate increased sharply in RoI (APC = +23.3%), and to a lesser degree in NI (APC = +9.7%) to reach 412 and 177 tests per 1,000 men in 2004, respectively. Prostatic biopsy rates rose in both countries, but were twofold higher in RoI. Cancer incidence rates rose significantly, mirroring biopsy trends, in both countries reaching 440 per 100,000 men in RoI in 2004 compared to 294 in NI. Median age at diagnosis was lower in RoI (71 years) compared to NI (73 years) (p < 0.01) and decreased significantly over time in both countries. Mortality rates declined from 1995 in both countries (APC = -1.5% in RoI, -1.3% in NI) at a time when PSA testing was not widespread. CONCLUSIONS Prostatic biopsy rates, rather than PSA testing per se, were the main driver of prostate cancer incidence. Because mortality decreases started before screening became widespread in RoI, and mortality remained low in NI, PSA testing is unlikely to be the explanation for declining mortality.
Collapse
Affiliation(s)
- A-E Carsin
- National Cancer Registry Ireland, Cork, Ireland.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Bradley MC, Hughes CM, Cantwell MM, Napolitano G, Murray LJ. Non-steroidal anti-inflammatory drugs and pancreatic cancer risk: a nested case-control study. Br J Cancer 2010; 102:1415-21. [PMID: 20372155 PMCID: PMC2865751 DOI: 10.1038/sj.bjc.6605636] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Non-steroidal anti-inflammatory drug (NSAID) use has been linked with pancreatic cancer risk; however, findings from epidemiological studies are inconsistent. Methods: A nested case–control study was conducted within the UK General Practice Research Database. Cases (n=1141) had a diagnosis of primary cancer of the exocrine pancreas between January 1995 and June 2006. Controls (n=7954) were matched with each case on general practice site, sex and year of birth. Conditional logistic regression analyses were used to generate odds ratios (OR) and 95% confidence intervals (CI) associated with NSAID use compared with non-use. Results: Any use of NSAID in the 5 years before the index date or since entry into the database (excluding the year before diagnosis) was not associated with risk of pancreatic cancer; OR 0.96 (95% CI, 0.84–1.10) and 1.03 (95% CI 0.89–1.19), respectively. Exposure to NSAIDs for > 773 days, in the 5 years pre-diagnosis, was associated with a reduced risk of pancreatic cancer OR 0.78 (95%CI 0.62–0.97). There was evidence of reduced pancreatic cancer risk with long-term use (5 years or more) of lower doses of NSAIDs OR 0.70 (95% CI 0.49–0.99). Conclusion: Long-term exposure to NSAIDs may be associated with a reduction in risk of pancreatic cancer.
Collapse
Affiliation(s)
- M C Bradley
- Cancer Epidemiology and Prevention Research Group, Centre for Public Health, Queen's University, Mulhouse Building, Royal Victoria Hospital, Belfast BT12 6BJ, Northern Ireland, UK
| | | | | | | | | |
Collapse
|
27
|
Donnelly M, Anderson LA, Johnston BT, Watson RGP, Murphy SJ, Comber H, McGuigan J, Reynolds JV, Murray LJ. Oesophageal cancer: caregiver mental health and strain. Psychooncology 2009; 17:1196-201. [PMID: 18470954 DOI: 10.1002/pon.1337] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate strain and mental health among family caregivers of oesophageal cancer patients and possible factors associated with caregiver mental health and strain. METHODS Patients with oesophageal adenocarcinoma in Ireland were recruited into the FINBAR study (the main aim of which was to investigate factors influencing the Barrett's adenocarcinoma relationship). Carers completed the 13-item Caregiver Strain Index and the General Health Questionnaire-30 (GHQ) in the context of a brief interview with trained research staff that was undertaken separately from the interview with each cancer patient. RESULTS Two hundred and twenty-seven patients participated in the FINBAR study. A total of 39 patients did not have a family carer or the carer could not be identified. Fifty percent (94/188) of carers completed the questionnaires. Mean (SD) scores for strain (6.65, SD=3.63) and mental health status (10.21, SD=7.30) were high and 71% of carers scored >5 on the GHQ indicating psychological distress. There was a statistically significant positive relationship between level of strain experienced by caregivers and the severity of their mental health status and whether or not carers scored >5 on the GHQ. Relatives were 1.70 (95% CI 1.34-2.15) times more likely to be defined as high scorers with each unit increase in the CSI score. CONCLUSIONS A significant proportion of caregivers experienced high levels of strain and psychological distress. There is a need to provide appropriate support and services targeted specifically at reducing the considerable strain of caring for patients with oesophageal cancer, particularly for carers of patients from lower socioeconomic groups.
Collapse
Affiliation(s)
- M Donnelly
- Centre for Clinical and Population Sciences, Queen's University, Belfast, Northern Ireland.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Cantwell MM, Murray LJ, Catney D, Donnelly D, Autier P, Boniol M, Fox C, Middleton RJ, Dolan OM, Gavin AT. Second primary cancers in patients with skin cancer: a population-based study in Northern Ireland. Br J Cancer 2009; 100:174-7. [PMID: 19127269 PMCID: PMC2634689 DOI: 10.1038/sj.bjc.6604842] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 11/21/2008] [Accepted: 11/28/2008] [Indexed: 11/23/2022] Open
Abstract
Among all 14,500 incident cases of basal cell carcinoma (BCC), 6405 squamous cell carcinomas (SCC) and 1839 melanomas reported to the Northern Ireland Cancer Registry between 1993 and 2002, compared with the general population, risk of new primaries after BCC or SCC was increased by 9 and 57%, respectively. The subsequent risk of cancer, overall, was more than double after melanoma.
Collapse
Affiliation(s)
- M M Cantwell
- Cancer Epidemiology and Prevention Research Group, Centre for Clinical and Population Sciences, Queen's University Belfast, Belfast, Northern Ireland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Connolly D, Black A, Murray LJ, Nambirajan T, Keane PF, Gavin A. Repeating an abnormal prostate-specific antigen (PSA) level: how relevant is a decrease in PSA? Prostate Cancer Prostatic Dis 2008; 12:47-51. [DOI: 10.1038/pcan.2008.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
30
|
Abstract
Using population-based linked birth and cancer registry data, we investigated whether the risk of brain tumour in childhood (n=155) was associated with perinatal risk factors. This population-based cohort showed that being born into a larger family or to a mother with a history of miscarriage may increase childhood brain tumour risk.
Collapse
Affiliation(s)
- M M Cantwell
- Centre for Clinical and Population Sciences, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast BT12 6BJ, UK.
| | | | | | | |
Collapse
|
31
|
Anderson LA, Murphy SJ, Johnston BT, Watson RGP, Ferguson HR, Bamford KB, Ghazy A, McCarron P, McGuigan J, Reynolds JV, Comber H, Murray LJ. Relationship between Helicobacter pylori infection and gastric atrophy and the stages of the oesophageal inflammation, metaplasia, adenocarcinoma sequence: results from the FINBAR case-control study. Gut 2008; 57:734-9. [PMID: 18025067 DOI: 10.1136/gut.2007.132662] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE A number of studies have shown an inverse association between infection with Helicobacter pylori and oesophageal adenocarcinoma (OAC). The mechanism of the apparent protection against OAC by H pylori infection and, in particular, the role of gastric atrophy is disputed. The relationship between all stages of the oesophageal inflammation, metaplasia, adenocarcinoma sequence and H pylori infection and gastric atrophy was explored. METHODS A case-control study involving 260 population controls, 227 OAC, 224 Barrett's oesophagus (BO) and 230 reflux oesophagitis (RO) patients recruited within Ireland was carried out. H pylori and CagA (cytotoxin-associated gene product A) infection was diagnosed serologically by western blot, and pepsinogen I and II levels were measured by enzyme immunoassay. Gastric atrophy was defined as a pepsinogen I/II ratio of <3. RESULTS H pylori seropositivity was inversely associated with OAC, BO and RO; adjusted ORs (95% CIs), 0.49 (0.31 to 0.76), 0.35 (0.22 to 0.56) and 0.42 (0.27 to 0.65), respectively. Gastric atrophy was uncommon (5.3% of all subjects), but was inversely associated with non-junctional OAC, BO and RO; adjusted ORs (95% CIs), 0.34 (0.10 to 1.24), 0.23 (0.05 to 0.96) and 0.27 (0.08 to 0.88), respectively. Inverse associations between H pylori and the disease states remained in gastric atrophy-negative patients. CONCLUSION H pylori infection and gastric atrophy are associated with a reduced risk of OAC, BO and RO. While use of the pepsinogen I/II ratio as a marker for gastric atrophy has limitations, these data suggest that although gastric atrophy is involved it may not fully explain the inverse associations observed with H pylori infection.
Collapse
Affiliation(s)
- L A Anderson
- Centre for Clinical and Population Sciences, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast BT12 6BJ, UK.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Mutunga M, Gallagher AM, Boreham C, Watkins DC, Murray LJ, Cran G, Reilly JJ. Socioeconomic differences in risk factors for obesity in adolescents in Northern Ireland. ACTA ACUST UNITED AC 2007; 1:114-9. [PMID: 17907324 DOI: 10.1080/17477160600569560] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
UNLABELLED OBJECTIVES. To test for socioeconomic differences in some biological and behavioral risk factors for obesity in a representative and contemporary sample of adolescents. METHODS Cohort study of 2 016 randomly selected 12- and 15-year-olds representative of Northern Ireland, studied in 2000. We tested for differences in obesity risk factors based on a priori hypotheses between adolescents from affluent (n=487) versus deprived (n=237) families. Potential risk factors were dietary energy and macronutrient intake, habitual physical activity, TV viewing and computer use, and physical fitness. RESULTS Adolescents of higher socioeconomic status reported significantly lower habitual energy intake (210 kJ/kg/d SD 80 vs. 229 kJ/kg/d SD 91, p < 0.01); significantly higher levels of habitual physical activity (physical activity score 25.9 SD 16.6 vs. 20.9 SD 16.4, p < 0.001), and had significantly higher cardiorespiratory fitness (estimated VO2 max 46.2 ml/kg/min SD 8.4 vs. 43.4 ml/kg/min SD 8.3, p < 0.001). Prevalence of overweight and obesity (BMI >85th percentile) in the cohort was 29.1% and was slightly but not significantly higher in the low (33.8%) versus the high (28.5%) socioeconomic groups. CONCLUSIONS Differences in some of the biological and behavioral risk factors for obesity exist between adolescents of different socioeconomic status in Northern Ireland. These may help explain the basis of established socioeconomic differences in obesity risk.
Collapse
Affiliation(s)
- M Mutunga
- University of Glasgow, Division of Developmental Medicine, Yorkhill Hospitals, Glasgow, Scotland
| | | | | | | | | | | | | |
Collapse
|
33
|
Gallagher AM, Robson PJ, Livingstone MBE, Cran GW, Strain JJ, Murray LJ, Savage JM, Boreham CAG. Tracking of energy and nutrient intakes from adolescence to young adulthood: the experiences of the Young Hearts Project, Northern Ireland. Public Health Nutr 2007; 9:1027-34. [PMID: 17125567 DOI: 10.1017/s1368980006009694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/06/2022]
Abstract
OBJECTIVE To assess tracking of energy and nutrient intakes between adolescence and young adulthood. DESIGN Longitudinal study of a random sample of adolescents (aged 15 years at baseline). The extent of tracking of dietary intakes (assessed by diet history) was investigated using weighted kappa statistics (kappa). SETTING Northern Ireland population survey. SUBJECTS Adolescents who participated in the Young Hearts Project, Northern Ireland at age 15 years, and subsequently at young adulthood aged between 20 and 25 years (n=245 males, n=231 females). RESULTS Despite overall increases in height and weight (both P<0.001), increases in body mass index in males (P<0.001) and body fatness in females (P<0.001), median reported intakes of energy (kJ kg(-1) day(-1)), carbohydrate (g day(-1)) and fat (g day(-1)) decreased (all P<0.001) over time. Expressed as nutrient densities (per MJ), diets at young adulthood were overall richer in thiamin, vitamin B6, total folate (all P<0.001), vitamin C (P<0.01) and vitamin D (P<0.05). Whereas the nutrient density of the males' diets decreased over time for calcium (P<0.05) and vitamin A (P<0.001), iron and riboflavin densities increased in the females' diet (P<0.001). Tracking of energy (MJ day(-1)) and nutrient intakes (expressed per MJ day(-1)) at the individual level was only poor to fair (all kappa<0.25), indicating substantial drift of subjects between the low, medium and high classes of intake with increasing age. CONCLUSIONS These data suggest that individual dietary patterns exhibited at 15 years of age are unlikely to be predictive of dietary intakes at young adulthood.
Collapse
Affiliation(s)
- A M Gallagher
- Northern Ireland Centre for Food and Health (NICHE), University of Ulster, Coleraine, UK.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Degnan BA, Murray LJ, Dunling CP, Whittlestone KD, Standley TDA, Gupta AK, Wheeler DW. The effect of additional teaching on medical students' drug administration skills in a simulated emergency scenario. Anaesthesia 2007; 61:1155-60. [PMID: 17090235 DOI: 10.1111/j.1365-2044.2006.04869.x] [Citation(s) in RCA: 17] [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
Medical students have difficulty calculating drug doses correctly, but better teaching improves their performance in written tests. We conducted a blinded, randomised, controlled trial to assess the benefit of online teaching on students' ability to administer drugs in a simulated critical incident scenario, during which they were scored on their ability to administer drugs in solution presented as a ratio (adrenaline) or percentage (lidocaine). Forty-eight final year medical students were invited to participate; 44 (92%) attended but only nine of the 20 students (45%) directed to the extra teaching viewed it. Nevertheless, the teaching module significantly improved the students' ability to calculate the correct volume of lidocaine (p = 0.005) and adrenaline (p = 0.0002), and benefited each student's overall performance (p = 0.0007). Drug administration error is a very major problem and few interventions are known to be effective. We show that focusing on better teaching at medical school may benefit patient safety.
Collapse
Affiliation(s)
- B A Degnan
- Department of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | | | | | | | | | | | | |
Collapse
|
35
|
Anderson LA, McMillan SA, Watson RGP, Monaghan P, Gavin AT, Fox C, Murray LJ. Malignancy and mortality in a population-based cohort of patients with coeliac disease or ‘gluten sensitivity’. World J Gastroenterol 2007; 13:146-51. [PMID: 17206762 PMCID: PMC4065872 DOI: 10.3748/wjg.v13.i1.146] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the risk of malignancy and mortality in patients with a positive endomysial or anti-gliadin antibody test in Northern Ireland.
METHODS: A population-based retrospective cohort study design was used. Laboratory test results used in the diagnosis of coeliac disease were obtained from the Regional Immunology Laboratory, cancer statistics from the Northern Ireland Cancer Registry and mortality statistics from the General Registrar Office, Northern Ireland. Age standardized incidence ratios of malignant neoplasms and standardized mortality ratios of all-cause and cause-specific mortality were calculated.
RESULTS: A total of 13 338 people had an endomysial antibody and/or an anti-gliadin antibody test in Northern Ireland between 1993 and 1996. There were 490 patients who tested positive for endomysial antibodies and they were assumed to have coeliac disease. There were 1133 patients who tested positive for anti-gliadin antibodies and they were defined as gluten sensitive. Malignant neoplasms were not significantly associated with coeliac disease; however, all-cause mortality was significantly increased following diagnosis. The standardized incidence and mortality ratios for non-Hodgkin’s lymphoma were increased in coeliac disease patients but did not reach statistical significance. Lung and breast cancer incidence were significantly lower and all-cause mortality, mortality from malignant neoplasms, non-Hodgkin’s lymphoma and digestive system disorders were significantly higher in gluten sensitive patients compared to the Northern Ireland population.
CONCLUSION: Patients with coeliac disease or gluten sensitivity had higher mortality rates than the Northern Ireland population. This association persists more than one year after diagnosis in patients testing positive for anti-gliadin antibodies. Breast cancer is significantly reduced in the cohort of patients with gluten sensitivity.
Collapse
Affiliation(s)
- L A Anderson
- Centre for Clinical and Population Sciences, Mulhouse Building, Grosvenor Road, Belfast, BT12 6BJ, United Kingdom,
| | | | | | | | | | | | | |
Collapse
|
36
|
Murphy SJ, Johnston BT, Murray LJ. British Society of Gastroenterology guidelines for the diagnosis of Barrett's oesophagus: are we casting the net too wide? Gut 2006; 55:1821-2. [PMID: 17124164 PMCID: PMC1856453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
|
37
|
Young JC, Wu S, Hansteen G, Du C, Sambucetti L, Remiszewski S, O'Farrell AM, Hill B, Lavau C, Murray LJ. Inhibitors of histone deacetylases promote hematopoietic stem cell self-renewal. Cytotherapy 2006; 6:328-36. [PMID: 16146885 DOI: 10.1080/14653240410004899] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Histone deacetylases (HDAC) are associated with a variety of transcriptional repressors that control cellular differentiation and proliferation. HDAC inhibitors such as trichostatin A, trapoxin and chlamydocin could be useful tools to modulate these cellular processes. We investigated their effect on the self-renewal of hematopoietic stem cells (HSC) during ex vivo culture. METHODS Purified murine HSC with the phenotype c-Kit+,Thy-1.1(lo), Lin(-/lo), Sca-1+ were cultured for 4 days with IL-3, IL-6 and c-Kit ligand without or with HDAC inhibitors, after which their degree of phenotypic differentiation in culture was assessed by flow cytometric analysis. To explore whether HDAC inhibitors could have a beneficial role in human HSC transplantation, mobilized peripheral blood CD34+ cells were cultured with thrombopoietin mimetic peptide, flt3 ligand, and c-Kit ligand, without or with various HDAC inhibitors. The fluorescent dye, carboxyfluorescein-diacetate succinimidylester (CFSE), was used to track division of cell subsets, and engrafting ability was evaluated in a non-obese diabetic (NOD) -SCID xenotransplantation model. RESULTS Murine HSC cultured with HDAC inhibitors maintained a more primitive phenotype than control cultures. The number of human HSC expressing Thy-1 increased up to seven-fold during a 5-day culture with HDAC inhibitors compared with control cultures. Chlamydocin was the most effective of the HDAC inhibitors tested at promoting Thy-1 expression on human cells. CFSE tracking showed that the increase in Thy-1+ cells resulted from cell division. In a NOD-SCID repopulation assay, cells exposed to chlamydocin for 24 h displayed an average four-fold higher engrafting ability over control cells. DISCUSSION Our studies suggest that HDAC inhibitors can induce ex vivo expansion of human HSC, and may improve engraftment in hematopoietic transplant patients when cell dose is limiting.
Collapse
|
38
|
Watkins DC, Murray LJ, McCarron P, Boreham CAG, Cran GW, Young IS, McGartland C, Robson PJ, Savage JM. Ten-year trends for fatness in Northern Irish adolescents: the Young Hearts Projects—repeat cross-sectional study. Int J Obes (Lond) 2005; 29:579-85. [PMID: 15889116 DOI: 10.1038/sj.ijo.0802945] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine secular trends in measures of fatness over a 10-y period (the 1990s) in Northern Irish schoolchildren. DESIGN Repeat cross-sectional surveys. SUBJECTS In total, 12- and 15-y-old children randomly selected from post-primary schools. A total of 1015 children studied between 1989 and 1990, and 2017 studied between 1999 and 2001. MEASUREMENTS The same study methods were applied in both surveys. Body mass index (BMI) was calculated from height and weight, and percentage body fat (%BF) was derived from skinfold measurements at four sites. Dietary intake was assessed using a diet history method and habitual physical activity (PA) was estimated from a self-report questionnaire. RESULTS Increases were seen in both height and weight in all age-sex groups. The overall prevalence of overweight/obesity increased from 15.0 to 19.6%, but 12-y-old girls contributed most to this increase (15.9-26.3%), with a modest increase observed also in 15-y-old boys. Increases in mean BMI (19.2-20.3 kg/m2) and mean %BF (25.8-27.1%) were seen in 12-y-old girls, with no significant changes in any of the other subgroups. Mean energy intake increased in girls but not in boys, while mean PA score decreased in 12-y-old girls, but was unchanged in the other three groups. All age-sex groups showed substantial increases in the sugar intake while fat intake increased in girls and decreased in boys. CONCLUSION Increases in indices of fatness were seen among school-age children in Northern Ireland during the 1990s. Trends differed between age-sex groups with the largest changes seen in 12-y-old girls. It remains to be seen whether the large increase in overweight/obesity in this group tracks into adulthood, with consequences for chronic disease incidence in women.
Collapse
Affiliation(s)
- D C Watkins
- Department of Paediatrics, Antrim Hospital, Northern Ireland, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Woodside JV, McMahon R, Gallagher AM, Cran GW, Boreham CA, Murray LJ, Strain JJ, McNulty H, Robson PJ, Brown KS, Whitehead AS, Savage M, Young IS. Total homocysteine is not a determinant of arterial pulse wave velocity in young healthy adults. Atherosclerosis 2004; 177:337-44. [PMID: 15530908 DOI: 10.1016/j.atherosclerosis.2004.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [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: 12/03/2003] [Accepted: 07/02/2004] [Indexed: 11/27/2022]
Abstract
AIMS Hyperhomocysteinaemia has been associated with reduced pulse wave velocity (PWV) in patients with end-stage renal disease and in those with hypertension. The aim of this study was to examine the association between total homocysteine (tHcy) concentrations, the biochemical and genetic determinants of tHcy and PWV in healthy young adults. METHODS AND RESULTS A total of 489 subjects aged 20-25 years participated. A fasting blood sample was taken and PWV measured using a non-invasive optical method. tHcy did not correlate with PWV, whether assessed at the aorto-iliac segment (P = 0.18), the aorto-radial segment (P = 0.39) or the aorto-dorsalis-pedis segment (P = 0.22). When tHcy was classified into normal (<15) and high (> or =15micromol/l), PWV did not differ between the two groups at any segment. PWV did not differ by MTHFR C677T or NOS3 G894T genotype, even when smoking and folate sub-groups were considered. Considering aortic PWV as a dependent variable, stepwise regression analysis showed that the only parameter entering the model for all segments was systolic blood pressure (aorto-iliac, P < 0.001; aorto-radial, P = 0.01; aorto-dorsalis-pedis, P = 0.001). Age, sex, COL1A1 genotype and triglycerides entered the model significantly for two of three segments. CONCLUSION This study shows that arterial PWV is not associated with tHcy in a healthy young population.
Collapse
Affiliation(s)
- J V Woodside
- School of Medicine, Queen's University, Mulhouse Building, Grosvenor Road, Belfast BT126BJ, Northern Ireland, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
OBJECTIVE To examine the pattern of use of prostate-specific antigen (PSA) testing in a UK region, where National Health Service policy does not recommend screening for prostate cancer. SUBJECTS AND METHODS Data were collected on all PSA tests in Northern Ireland between 1990 and 1999. Annual rates of PSA testing were calculated by age, GP Practice and year. RESULTS In all, 165 862 PSA tests were performed on 84 669 men, and over a third of men aged > or = 50 years had at least one PSA test. Men aged < 50 years accounted for 12.9% of first tests. The proportion of tests from primary care increased from 47.2% in 1993 to 67.0% in 1999. The mean age of men tested once decreased from 65.6 to 61.9 years (P trend < 0.001) and the proportion with an elevated PSA level also declined during the period. Repeat testing increased with PSA level (P < 0.001) but 29.4% of men with a PSA level of < or = 4 ng/mL also had repeat testing. Raised PSA values were more common from hospital than primary care (32.4% vs 20.6%, P < 0.001) and in older men. Test rates varied 100-fold across general practices, a finding not explained by sociodemographic factors, but one which reflects differential adherence to national guidelines, suggesting that general practitioners are key targets for attempting to rationalise the use of the PSA test. CONCLUSION These findings suggest that PSA screening is taking place against evidence-based advice and has resulted in over 20 000 men being designated as having a raised PSA level, creating a need for further assessment.
Collapse
Affiliation(s)
- A Gavin
- Northern Ireland Cancer Registry, Department of Epidemiology and Public Health, Queens University of Belfast, Mulhouse Building, Grosvenor Road, Belfast BT12 6BJ, UK.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
BACKGROUND Patients with Barrett's oesophagus have an increased risk of oesophageal adenocarcinoma but this cancer only accounts for a small proportion of deaths in these patients. Other causes of death are reportedly raised in this group. We examined cause specific mortality among individuals in a population based Barrett's oesophagus register. METHODS We constructed a register of all patients diagnosed with columnar mucosa (including specialised intestinal metaplasia) of the oesophagus within Northern Ireland between 1993 and 1999. Deaths occurring within this cohort until 31 December 2000 were identified and mortality rates were compared with the general population. RESULTS Overall mortality was not raised in Barrett's patients. During 7413 person years of follow up in 2373 patients there were 253 deaths (standardised mortality ratio (SMR) 96 (95% confidence interval (CI) 84-107)). Mortality from oesophageal cancer was raised in patients with specialised intestinal metaplasia (SMR 774 (95% CI 317-1231)) but only 4.7% of patients died from this cancer. Mortality from stroke (SMR 65 (95% CI 37-93)) was significantly lower than the general population while mortality from non-cancerous digestive system diseases was significantly higher (SMR 211 (95% CI 111-311)). Mortality rates from all other causes were similar to those of the general population. CONCLUSIONS This study demonstrates that the overall mortality rate in patients with Barrett's oesophagus is closely similar to that of the general population. Oesophageal cancer mortality was raised but is an uncommon cause of death in these patients who also appear to have a reduced risk of death from stroke.
Collapse
Affiliation(s)
- L A Anderson
- Northern Ireland Cancer Registry, Department of Epidemiology and Public Health, The Queen's University Belfast, UK.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Gallagher AM, Savage JM, Murray LJ, Davey Smith G, Young IS, Robson PJ, Neville CE, Cran G, Strain JJ, Boreham CA. A longitudinal study through adolescence to adulthood: the Young Hearts Project, Northern Ireland. Public Health 2002; 116:332-40. [PMID: 12407472 DOI: 10.1038/sj.ph.1900871] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2002] [Indexed: 11/09/2022]
Abstract
The Young Hearts (YH) Project is an ongoing study of biological and behavioural risk factors for cardiovascular disease in a representative sample of young people from Northern Ireland, a region of high coronary mortality. This article describes the cross-sectional clinical, dietary and lifestyle data obtained from individuals (aged 20-25 y) who participated in phase 3 of the project (YH3). A total of 489 individuals (251 males, 238 females) participated in YH3 (48.2% response rate). Some 31.1% of participants at YH3 were overweight (BMI >25 kg/m(2)) with 4.4% of males and 8.0% of females were obese (BMI >30 kg/m(2)). More females than males had a very poor fitness (55.0 vs 22.1%, chi-squared 51.70, d.f. 1, P<0.001) and did not participate in any sporting or exercise activity (38.4 vs 24.9%, chi-squared 10.26, d.f. 1, P=0.001). Over 20% of participants had a raised total serum cholesterol (>5.2 mmol/l). More females had a raised serum LDL-cholesterol (>3.0 mmol/l) than males (44.6 vs 34.6%, chi-squared 4.39, d.f. 1, P<0.05). Over 46% of participants reported energy intakes from fat above recommended levels, and 68.5% of participants had saturated fat intakes above those recommended (Dietary reference values for food energy and nutrients for the United Kingdom. HMSO: London, 1991). Just over half of the study population reported alcohol intakes in excess of recommended sensible limits set by the Royal College of Physicians (A great and growing evil: the medical consequences of alcohol abuse. Tavistock: London, 1987), with 36.7% of males and 13.4% of females reporting intakes over twice these recommended limits. A total of 37% of the study population smoked. During young adulthood, individuals may be less amenable to attend a health-related study and recruitment of participants to the current phase of the study proved a major problem. However, these data constitute a unique developmental record from adolescence to young adulthood in a cohort from Northern Ireland and provide additional information on the impact of early life, childhood and young adulthood on the development of risk for chronic disease.
Collapse
Affiliation(s)
- A M Gallagher
- Northern Ireland Centre for Diet and Health (NICHE), School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
McKay JA, Murray LJ, Curran S, Ross VG, Clark C, Murray GI, Cassidy J, McLeod HL. Evaluation of the epidermal growth factor receptor (EGFR) in colorectal tumours and lymph node metastases. Eur J Cancer 2002; 38:2258-64. [PMID: 12441262 DOI: 10.1016/s0959-8049(02)00234-4] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Overexpression of the epidermal growth factor receptor (EGFR) often correlates with an aggressive tumour phenotype and poor prognosis. To examine the relevance of EGFR in colorectal cancer, we determined the expression of EGFR protein in 249 colorectal adenocarcinomas and 42 lymph node metastases using immunohistochemistry. Moreover, we investigated a (CA)(n) dinucleotide repeat polymorphism of the EGFR gene in a subset of 114 tumours. High levels of EGFR protein were observed in 123/249 (49.4%) samples. EGFR expression in colorectal carcinomas correlated with differentiation grade (P=0.014). However, there were no associations with Dukes' stage, site, patient age or gender. EGFR protein expression did not influence survival in this colorectal cancer patient cohort (P>or=0.05). Expression was not identical in paired colorectal tumours and lymph node metastases, with only 17/42 (40.5%) samples showing equivalent EGFR levels (P>0.05). The distribution of the (CA)(n) dinucleotide repeat alleles in colorectal adenocarcinomas was not associated with EGFR protein expression (P>0.05). These results indicate that while EGFR overexpression is a common event in colorectal carcinogenesis, it does not influence patient prognosis.
Collapse
Affiliation(s)
- J A McKay
- Department of Medicine and Therapeutics, University of Aberdeen, Foresterhill, AB25 2ZD, Aberdeen, UK
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Harvey RF, Spence RW, Lane JA, Nair P, Murray LJ, Harvey IM, Donovan J. Relationship between the birth cohort pattern of Helicobacter pylori infection and the epidemiology of duodenal ulcer. QJM 2002; 95:519-25. [PMID: 12145391 DOI: 10.1093/qjmed/95.8.519] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [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] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Helicobacter-pylori-related duodenal ulcer (DU) is an important cause of dyspepsia. AIM To determine the relationship between the pattern of H. pylori infection and the epidemiology of duodenal ulcer in a single population. DESIGN Prospective two-part study of (i) patients with DU referred for endoscopy because of dyspepsia, and (ii) the incidence of H. pylori infection in the general population of the same area. METHODS Details of 533 DU patients were recorded, and related to the pattern of H. pylori infection among 10 537 adults in the same community, determined by the (13)C-urea breath test. RESULTS In patients with DU, birth year was more important than age in determining the rate of presentation for endoscopy (the 'birth cohort' effect). H. pylori infection showed a similar birth cohort effect, and the prevalence decreased steadily in those born in successive years, from 28.8% in the 1930s to 3.5% in the 1970s. The proportion of dyspeptic patients who had duodenal ulcers also fell progressively, from 22.2% in 1979 to 5.7% in 1998. H. pylori prevalence and duodenal ulcer incidence were closely correlated at all ages. DISCUSSION Duodenal ulcer prevalence (as judged by the rate of referral of duodenal ulcer patients for endoscopy) is determined principally by the distribution of H. pylori infection in the local population. The birth cohort effect seen in adult duodenal ulcer patients reflects the acquisition of H. pylori in childhood. In Bristol, H. pylori prevalence and duodenal ulcer incidence are both declining to very low levels.
Collapse
Affiliation(s)
- R F Harvey
- Department of Medicine, Frenchay Hospital, Bristol, UK.
| | | | | | | | | | | | | |
Collapse
|
45
|
Neville CE, Murray LJ, Boreham CAG, Gallagher AM, Twisk J, Robson PJ, Savage JM, Kemper HCG, Ralston SH, Davey Smith G. Relationship between physical activity and bone mineral status in young adults: the Northern Ireland Young Hearts Project. Bone 2002; 30:792-8. [PMID: 11996922 DOI: 10.1016/s8756-3282(02)00711-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [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: 11/22/2022]
Abstract
Physical activity during the first three decades of life may increase peak bone mass and reduce future osteoporosis risk. The aim of this study was to determine the extent to which different components of physical activity may influence bone mineral status within a representative population sample of young men and women. Bone mineral density (BMD) and content (BMC) were determined at the lumbar spine and femoral neck in 242 men and 212 women, aged 20-25 years, by dual-energy X-ray absorptiometry. Physical activity was assessed by a self-report questionnaire designed to measure the frequency and duration of physical activity and its components (i.e., work, non-sports leisure, sports-related activities, and peak strain sports activities). Potential confounding factors such as height, weight, diet, and smoking habits were also assessed. In multivariate linear regression models, sports activity and peak strain sports activity undertaken by men were strongly associated with both lumbar spine BMD (beta = 0.35 [0.21, 0.49] and beta = 0.31 [0.17, 0.44], respectively) and BMC (beta = 0.33 [0.21, 0.45] and beta = 0.26 [0.14, 0.38], respectively) and femoral neck BMD (beta = 0.35 [0.21, 0.48] and beta = 0.27 [0.14, 0.40], respectively) and BMC (beta = 0.32 [0.19, 0.44] and beta = 0.29 [0.17, 0.41], respectively) (all p < 0.01), but work and non-sports leisure activities were not. In women, there were no associations between bone measurements and any component of physical activity. In models involving all subjects the gender/sports activity, but not the gender/peak strain, interaction term was statistically significant. Sports activity explained 10.4% of the observed variance in lumbar spine BMD in men, but <1% in women. These results demonstrate the importance of sports activities, especially those involving high peak strain, in determining peak bone status in young men. Failure to observe this association in women reflects their lower participation in such activities, but they may have the same capacity to benefit from these activities as men. Intervention studies are warranted to determine whether peak bone density in women can be improved by participating, during childhood and adolescence, in sports activities involving high peak strain.
Collapse
Affiliation(s)
- C E Neville
- School of Applied Medical Sciences and Sports Studies, University of Ulster, Jordanstown, Shore Road, Newtownabbey BT37 0QB, Northern Ireland, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Neville CE, Robson PJ, Murray LJ, Strain JJ, Twisk J, Gallagher AM, McGuinness M, Cran GW, Ralston SH, Boreham CAG. The effect of nutrient intake on bone mineral status in young adults: the Northern Ireland young hearts project. Calcif Tissue Int 2002; 70:89-98. [PMID: 11870414 DOI: 10.1007/s00223-001-1023-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [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: 02/22/2001] [Accepted: 10/24/2001] [Indexed: 10/28/2022]
Abstract
Optimizing peak bone mass in early life may reduce osteoporosis risk in later life. Such optimization may be partly dependent upon diet. In the present study, nutrient intakes and selected lifestyle parameters were assessed in adolescent subjects (238 males, 205 females; aged 15 y) and again, in the same subjects, on one occasion in young adulthood (aged between 20 and 25 y). The extent of the relationships between these parameters and bone mineral density (BMD), dual energy X-ray absorptiometry (DXA), lumbar spine (L2-L4), and femoral neck measured concurrently with diet in young adulthood only, was assessed. Adjusted linear regression models were constructed. Variables included a measure of pubertal status (at age 15 y), age (at young adulthood), height, weight, physical activity, smoking, and mean daily intakes of energy, calcium, protein, vitamin D, phosphorus, total fat, and alcohol. In both sexes, body weight at adolescence and young adulthood was the only factor consistently positively associated with BMD at both measurement sites. Effects of nutrient intake on BMD were inconsistent. Vitamin D and calcium intakes reported by female adolescents showed significant positive relationships with BMD measured in young adulthood (vitamin D measured at the lumbar spine; calcium measured at the femoral neck). The positive relationship between vitamin D and BMD remained significant at young adulthood, but at the femoral neck rather than at the lumbar spine. Also in females, intakes of phosphorus and the calcium:phosphorus ratio (Ca:P) at adolescence were strongly negatively related to femoral neck BMD measured at young adulthood. In males, however, Ca:P reported at young adulthood had a significant positive relationship with lumbar spine BMD, whereas Ca:protein was negatively associated with BMD at the lumbar spine. Intakes of Ca reported by adolescent males also had a strong negative effect on lumbar spine BMD measured at young adulthood.
Collapse
Affiliation(s)
- C E Neville
- School of Applied Medical Sciences and Sports Studies, University of Ulster, Jordanstown, Northern Ireland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Brull DJ, Murray LJ, Boreham CA, Ralston SH, Montgomery HE, Gallagher AM, McGuigan FE, Davey Smith G, Savage M, Humphries SE, Young IS. Effect of a COL1A1 Sp1 binding site polymorphism on arterial pulse wave velocity: an index of compliance. Hypertension 2001; 38:444-8. [PMID: 11566920 DOI: 10.1161/01.hyp.38.3.444] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
-Reduced arterial compliance precedes changes in blood pressure, which may be mediated through alterations in vessel wall matrix composition. We investigated the effect of the collagen type I-alpha1 gene (COL1A1) +2046G>T polymorphism on arterial compliance in healthy individuals. We recruited 489 subjects (251 men and 238 women; mean age, 22.6+/-1.6 years). COL1A1 genotypes were determined using polymerase chain reaction and digestion by restriction enzyme Bal1. Arterial pulse wave velocities were measured in 3 segments, aortoiliac (PWVA), aortoradial (PWVB), and aorto-dorsalis-pedis (PWVF), as an index of compliance using a noninvasive optical method. Data were available for 455 subjects. The sample was in Hardy-Weinberg equilibrium with genotype distributions and allele frequencies that were not significantly different from those reported previously. The T allele frequency was 0.22 (95% confidence interval, 0.19 to 0.24). Two hundred eighty-three (62.2%) subjects were genotype GG, 148 (35.5%) subjects were genotype GT, and 24 (5.3%) subjects were genotype TT. A comparison of GG homozygotes with GT and TT individuals demonstrated a statistically significant association with arterial compliance: PWVF 4.92+/-0.03 versus 5.06+/-0.05 m/s (ANOVA, P=0.009), PWVB 4.20+/-0.03 versus 4.32+/-0.04 m/s (ANOVA, P=0.036), and PWVA 3.07+/-0.03 versus 3.15+/-0.03 m/s (ANOVA, P=0.045). The effects of genotype were independent of age, gender, smoking, mean arterial pressure, body mass index, family history of hypertension, and activity scores. We report an association between the COL1A1 gene polymorphism and arterial compliance. Alterations in arterial collagen type 1A deposition may play a role in the regulation of arterial compliance.
Collapse
Affiliation(s)
- D J Brull
- Division of Cardiovascular Genetics, Department of Medicine, Royal Free and UCL Medical School, London, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Murray LJ, Gallagher AM, Boreham CA, Savage M, Smith GD. Sex specific difference in the relation between birth weight and arterial compliance in young adults: The Young Hearts Project. J Epidemiol Community Health 2001; 55:665-6. [PMID: 11511646 PMCID: PMC1731966 DOI: 10.1136/jech.55.9.665] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- L J Murray
- Department of Epidemiology and Public Health, The Queens's University of Belfast, Riddell Hall, Stranmillis Road, Belfast BT9 5EE, UK.
| | | | | | | | | |
Collapse
|
49
|
Abstract
Recent evidence suggests potential associations between birthweight and disease in later life. For resource or other reasons recorded birthweight may be unavailable to researchers who have access to uniquely relevant outcome data. The present study examined the validity of parental recall of birthweight. Parents of 1015 males and females aged 12 and 15 years participating in the Young Hearts Study (a cluster random sample of 1015 males and females aged 12 and 15 years from post-primary schools in Northern Ireland) completed a questionnaire which included a question about their child's birthweight. The answer provided was compared with recorded birthweight obtained from archived computerised child health records with a cut-off point for inaccurate reporting set at +/- 227 g (1/2 lb). The influence of social class and weight at birth on accuracy of recall was also determined. A total of 84.8% of parents accurately recalled their child's birthweight to within 227 g. Parents from non-manual occupation social classes recalled birthweight more accurately than those from manual occupation social classes (88.0 vs. 82.6% accurate: chi2 = 4.81, p = 0.03). Parents of low birthweight infants tended to recall their birthweight less accurately than parents of normal weight infants: 76.1% accurate compared to 86.1% accurate: chi2 = 3.54, p = 0.06. Parents of high birthweight infants recalled their birthweight less accurately than parents of normal weight infants: 78.5% accurate: chi2 = 3.94, p = 0.05. In conclusion, parentally recalled birthweight may be a suitable proxy for recorded birthweight for population based research into disease in childhood and adolescence.
Collapse
Affiliation(s)
- K A Walton
- The Nuffield Department of Child Health, Institute of Clinical Science, The Queen's University of Belfast, UK
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
OBJECTIVE To determine the extent to which meteorologic factors explain seasonality in birth weight in a developed country. METHODS Recorded birth weights were collected for all singleton live births after 36 weeks of pregnancy in Northern Ireland between 1971 and 1986. Data on daily maximum and minimum temperatures, rainfall, and hours of bright sunshine were obtained from a local climatologic station for the same period. For each birth, mean daily maximum and minimum temperatures, rainfall, and hours of bright sunshine were calculated for the trimesters of the pregnancy. Linear regression models were constructed with birth weight as the dependent variable and month of birth as a predictor variable. Months of birth were entered in the models as dummy variables. Adjustment was made for year of birth, duration of gestation, maternal age, number of previous pregnancies, sex, and social class of infants at birth and for meteorologic variables relating to each trimester. RESULTS A clear seasonal pattern in birth weight was observed, with lowest mean birth weight in late spring and summer. Adjusted mean birth weights were 25.5 g, 29.6 g, and 31.6 g lower in May, June, and July, respectively, than in January. This seasonal variation occurred in both sexes, and in female births, it disappeared almost entirely after adjustment for mean daily maximum temperature during the second trimester of pregnancy. CONCLUSION Infants born during late spring and summer are lighter than those born in winter, which might be the result of exposure to low winter temperatures during midgestation. Pregnant women should keep themselves warm during midpregnancy.
Collapse
Affiliation(s)
- L J Murray
- Department of Epidemiology and Public Health, The Queens University of Belfast, Belfast, United Kingdom.
| | | | | | | | | | | |
Collapse
|