34 results on '"Elizabeth New"'
Search Results
2. Psychological health declined during the post-monsoon season in communities impacted by sea-level rise in Bangladesh
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Sajjad Kabir, Elizabeth Newnham, Ashraf Dewan, Md. Monirul Islam, and Takeshi Hamamura
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Geology ,QE1-996.5 ,Environmental sciences ,GE1-350 - Abstract
Abstract Sea level rise affects the long-term psychological health of coastal communities. However, research on long-term and seasonal impacts on vulnerable communities’ psychological health is limited. Here, we explore the effect of sea-level rise on the psychological health of the coastal population in Satkhira and Khulna districts of southwest Bangladesh across two seasons: before monsoon (March to April) and post-monsoon months (October to November) in 2021. We leveraged the longitudinal research that involved 1144 participants. We collected data on psychological health using established scales for distress, depression, anxiety, and stress and also measured environmental factors and resource losses. Results indicate that psychological health, particularly distress, depression, anxiety, and stress, increased during the post-monsoon months in communities more vulnerable to sea-level rise. Highly vulnerable communities showed increased psychological distress post-monsoon. Environmental stressors and resource loss escalated during the post-monsoon period, especially in moderate and highly vulnerable communities. Our findings emphasize the urgent need for targeted support and resilience-building interventions in affected communities to alleviate the psychological health impacts of sea-level rise.
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- 2024
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3. Deficits in mitochondrial function and glucose metabolism seen in sporadic and familial Alzheimer’s disease derived Astrocytes are ameliorated by increasing hexokinase 1 expression
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Simon M Bell, Hollie Wareing, Alexander Hamshaw, Suman De, Elizabeth New, Pamela J Shaw, Matteo De Marco, Annalena Venneri, Daniel J Blackburn, Laura Ferraiuolo, and Heather Mortiboys
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BackgroundAstrocytes have multiple roles including providing neurons with metabolic substrates and maintaining neurotransmitter synaptic homeostasis. Astrocyte glucose metabolism plays a key role in learning and memory with astrocytic glycogen a key substrate supporting memory encoding. The neuronal support provided by astrocytes has a high metabolic demand. Deficits in astrocytic mitochondrial metabolic functioning and glycolysis could impair neuronal function. Changes to cellular metabolism are seen early in Alzheimer’s disease (AD). Understanding cellular metabolism changes in AD astrocytes could be exploited as a new biomarker or synergistic therapeutic agent when combined with anti-amyloid treatments in AD.MethodsIn this project, we characterised mitochondrial and glycolytic function in astrocytes derived from patients with sporadic (n=6) and familial (PSEN1, n=3) forms of AD. Astrocytes were derived using direct reprogramming methods. Astrocyte metabolic outputs: ATP, and extracellular lactate levels were measured using luminescent and fluorescent protocols. Mitochondrial respiration and glycolytic function were measured using a Seahorse XF Analyzer. Hexokinase deficits identified where corrected by transfecting astrocytes with an adenovirus viral vector containing the hexokinase 1 gene.ResultsThere was a reduction of total cellular ATP of 20% (p=0.05 in sAD astrocytes) and of 48% (pConclusionAD astrocytes have abnormalities in functional capacity of mitochondria and the process of glycolysis. These functional deficits can be improved by correcting hexokinase expression deficits with adenoviral vectors. This suggests that hexokinase 1 deficiency could potentially be exploited as a new therapeutic target for AD.
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- 2023
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4. The Value of Constructivist Grounded Theory in Advocating for Unheard Voices in Contemporary Maternity Research
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Elysse Prussing, Elizabeth Newnham, and Allison Cummins
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Social sciences (General) ,H1-99 - Abstract
There is growing concern that maternity research trends have enabled the proliferation of medically orientated research methods. While this trend has helped demonstrate the safety and quality of midwifery care, it has also enabled a culture of valuing medical research approaches, over more critical, creative and explorative qualitative research. Consequently, a serious imbalance exists within maternity evidence, the majority focusing on treatment of maternity complications rather than what would benefit the mainstream of low-risk women - perpetuating a culture of medically-led maternity care as the prevailing option. Constructivist grounded theory is one approach that can help address current maternity research limitations. This paper highlights capacity within its processes to ask different questions, embracing diverse ways of knowing and unpacking the importance of research remaining woman-centred. There is a need to prioritise such research approaches, raising the perspectives of maternity users and identifying what matters most to women and birthing people themselves.
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- 2024
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5. An engagement framework for the authentic co-design of a consent and healthy relationships intervention with upper-secondary students
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Ashleigh M. Pantaleo, Peta L. Dzidic, Elizabeth Newnham, HuiJun Chih, Robert Wells, Brad Olson, Sarah Langley, Adrian Schonfeld, and Jacqueline Hendriks
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co-design ,participatory action research ,consent ,healthy relationships ,secondary education ,Reproduction ,QH471-489 ,Medicine (General) ,R5-920 - Abstract
IntroductionThe objective of this demand driven research is to co-design an intervention for upper-secondary students that addresses issues of consent and healthy relationships. In this paper, we (university researchers, student co-researchers, school staff), present the engagement framework that has been critical to the project's development and planned implementation.MethodsAn iterative co-design approach grounded in a participatory research approach is currently being adopted. Student co-researchers from three independent secondary schools on Whadjuk Nyungar Country in Boorloo/Perth, Western Australia, have been engaged as co-researchers in the design of the intervention. Supplementary quantitative and qualitative data from students enrolled at each school site is also being collated to further inform the intervention design. Student co-researchers will provide insights on the overarching design of the intervention including: the scope of key concepts they want to learn, interpretation of supplementary data, and the development of contextually relevant educative content.ResultsRetrospective and prospective components of the engagement framework are described and supported with applied examples where applicable. Preliminary results demonstrate the imperative of adopting iterative co-design, and the efficacy of our authentic engagement framework. A draft intervention has been formalized and will soon undergo piloting. The co-design process has already resulted in an intervention that differs from the initial program first conceptualized by university researchers.ConclusionImperative to our engagement framework is centering students as experts of their lived experience. It is anticipated that this engagement framework will provide insights around the feasibility, value, and necessity for authentic engagement of upper-secondary school students in the design of their consent and healthy relationship education.
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- 2024
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6. Stable tensor neural networks for efficient deep learning
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Elizabeth Newman, Lior Horesh, Haim Avron, and Misha E. Kilmer
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tensor algebra ,deep learning ,machine learning ,image classification ,inverse problems ,Information technology ,T58.5-58.64 - Abstract
Learning from complex, multidimensional data has become central to computational mathematics, and among the most successful high-dimensional function approximators are deep neural networks (DNNs). Training DNNs is posed as an optimization problem to learn network weights or parameters that well-approximate a mapping from input to target data. Multiway data or tensors arise naturally in myriad ways in deep learning, in particular as input data and as high-dimensional weights and features extracted by the network, with the latter often being a bottleneck in terms of speed and memory. In this work, we leverage tensor representations and processing to efficiently parameterize DNNs when learning from high-dimensional data. We propose tensor neural networks (t-NNs), a natural extension of traditional fully-connected networks, that can be trained efficiently in a reduced, yet more powerful parameter space. Our t-NNs are built upon matrix-mimetic tensor-tensor products, which retain algebraic properties of matrix multiplication while capturing high-dimensional correlations. Mimeticity enables t-NNs to inherit desirable properties of modern DNN architectures. We exemplify this by extending recent work on stable neural networks, which interpret DNNs as discretizations of differential equations, to our multidimensional framework. We provide empirical evidence of the parametric advantages of t-NNs on dimensionality reduction using autoencoders and classification using fully-connected and stable variants on benchmark imaging datasets MNIST and CIFAR-10.
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- 2024
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7. Cognitive Remediation in Bipolar (CRiB2): study protocol for a randomised controlled trial assessing efficacy and mechanisms of cognitive remediation therapy compared to treatment as usual
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Dimosthenis Tsapekos, Rebecca Strawbridge, Matteo Cella, Kimberley Goldsmith, Michail Kalfas, Rosie H. Taylor, Samuel Swidzinski, Steven Marwaha, Libby Grey, Elizabeth Newton, Julie Shackleton, Paul J. Harrison, Michael Browning, Catherine Harmer, Hannah Hartland, David Cousins, Stephen Barton, Til Wykes, and Allan H. Young
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Bipolar disorder (BD) ,Cognitive remediation (CR) ,Randomised controlled trial (RCT) ,Efficacy ,Mechanisms ,Trial protocol ,Psychiatry ,RC435-571 - Abstract
Abstract Background A substantial proportion of people with bipolar disorder (BD) experience persistent cognitive difficulties associated with impairments in psychosocial functioning and a poorer disorder course. Emerging evidence suggests that cognitive remediation (CR), a psychological intervention with established efficacy in people with schizophrenia, can also benefit people with BD. Following a proof-of-concept trial showing that CR is feasible and potentially beneficial for people with BD, we are conducting an adequately powered trial in euthymic people with BD to 1) determine whether an individual, therapist-supported, computerised CR can reduce cognitive difficulties and improve functional outcomes; and 2) explore how CR exerts its effects. Methods CRiB2 is a two-arm, assessor-blind, multi-site, randomised controlled trial (RCT) comparing CR to treatment-as-usual (TAU). Participants are people with a diagnosis of BD, aged between 18 and 65, with no neurological or current substance use disorder, and currently euthymic. 250 participants will be recruited through primary, secondary, tertiary care, and the community. Participants will be block-randomised (1:1 ratio, stratified by site) to continue with their usual care (TAU) or receive a 12-week course of therapy and usual care (CR + TAU). The intervention comprises one-on-one CR sessions with a therapist supplemented with independent cognitive training for 30–40 h in total. Outcomes will be assessed at 13- and 25-weeks post-randomisation. Efficacy will be examined by intention-to-treat analyses estimating between-group differences in primary (i.e., psychosocial functioning at week 25 measured with the Functional Assessment Short Test) and secondary outcomes (i.e., measures of cognition, mood, patient-defined goals, and quality of life). Global cognition, metacognitive skills, affect fluctuation, and salivary cortisol levels will be evaluated as putative mechanisms of CR through mediation models. Discussion This study will provide a robust evaluation of efficacy of CR in people with BD and examine the putative mechanisms by which this therapy works. The findings will contribute to determining the clinical utility of CR and potential mechanisms of action. Trial registration Cognitive Remediation in Bipolar 2 (CRiB2): ISRCTN registry: https://www.isrctn.com/ISRCTN10362331 . Registered 04 May 2022. Overall trial status: Ongoing; Recruitment status: Recruiting.
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- 2023
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8. Shaping research for people living with co‐existing mental and physical health conditions: A research priority setting initiative from the United Kingdom
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Olivia Taylor, Elizabeth Newbronner, Helen Cooke, Lauren Walker, and Ruth Wadman
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mental illness ,multimorbidity ,physical health ,public involvement ,research priorities ,Medicine (General) ,R5-920 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Introduction Those with severe and enduring mental ill health are at greater risk of long‐term physical health conditions and have a reduced life expectancy as a result. Multiple factors compound this health inequality, and the need for setting research priorities in this area is highlighted with physical and mental healthcare services being separate, and limited multimorbidity research. Methods The aim of this exercise was to work in partnership with healthcare professionals and carers, family, friends and individuals with lived experience of both mental and physical health conditions, to set research priorities to help people with mental health conditions to look after their physical health. The exercise was guided by the James Lind Alliance approach. For this, a steering group was set up, two surveys were completed and a final priority workshop was conducted. Results This priority setting exercise guided by people's needs and lived experience has produced a set of well‐defined research topics. Initially, 555 research questions were suggested in the first survey, which were refined to 54 questions for the second survey. A priority setting workshop was then conducted to get the final 10 priorities. Conclusions Taking these topics forward to improve services and treatment for both mental and physical ill health may in turn improve physical health and lessen the reduced life expectancy of those living with mental ill health. Patient or Public Contribution This work was completed in collaboration with people who have lived experience of mental ill health and physical health conditions, as well as carers, family and friends. Their contribution has been significant for this work from piloting surveys, amending language used and educating the researchers and contributing to this paper. The initial work was completed with a steering group and continued with surveys and workshops.
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- 2024
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9. Produce safety alliance grower training knowledge assessment results
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Lendel Narine, Arlene Enderton, Matt Benge, Elizabeth Bihn, Stephanie Brown, Jovana Kovacevic, Elizabeth Newbold, Keith Schneider, and Angela Shaw
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evaluation ,fruits ,vegetables ,knowledge ,assessment ,grower training ,Agriculture ,Social Sciences - Abstract
The Produce Safety Alliance (PSA) Grower Training (GT) curriculum was developed to provide produce growers with training that meets requirements in §112.22(c) of the Food Safety Modernization Act (FSMA) Produce Safety Rule (PSR). Four regional food safety centers evaluated course attendees’ knowledge change over four years (2019 to 2022) using a pre- and post-test quiz. Knowledge assessment results showed (a) respondents gained knowledge on each of the seven modules presented in the curriculum; (b) the curriculum content had a large effect on knowledge gain; (c) knowledge gain differed significantly between years, but the differences were not of practical importance; (d) remote participants learned significantly more than in-person participants, but differences were not of practical importance; and (e) the quiz consisted of low and moderate difficulty questions (no questions were high difficulty) and had generally acceptable discriminant properties. Implementation of the FSMA PSR has progressed from an educational to a regulatory phase, and the authors recommend replacing the knowledge assessment with a tool that measures how the PSA course prepares growers for compliance.
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- 2024
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10. Cost-effectiveness and benefits of perinatal health interventions in high-income settings: A protocol for a systematic review of economic evaluations.
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Tsegaye G Haile, Gizachew A Tessema, Lucas Hertzog, Elizabeth Newnham, Berihun Assefa Dachew, and Marshall Makate
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Medicine ,Science - Abstract
BackgroundDespite ongoing efforts, perinatal morbidity and mortality persist across all settings, imposing a dual burden of clinical and economic strain. Besides, the fragmented nature of economic evidence on perinatal health interventions hinders the formulation of effective health policies. Our review aims to comprehensively and critically assess the economic evidence for such interventions in high-income countries, where the balance of health outcomes and fiscal prudence is paramount.Methods and analysisWe will conduct a comprehensive search for studies using databases including EconLit (EBSCO), Cost Effectiveness Analysis (CEA) Registry, Medline (Ovid), Embase (Ovid), CINAHL Ultimate (EBSCO), Global Health (Ovid), and PubMed. Furthermore, we will broaden our search to include Google Scholar and conduct snowballing from the final articles included. The search terms will encompass economic evaluation, perinatal health interventions, morbidity and mortality, and high-income countries. We will include full economic evaluations focusing on cost-effectiveness, cost-benefit, cost-utility, and cost-minimisation analyses. We will exclude partial economic evaluations, reports, qualitative studies, conference papers, editorials, and systematic reviews. Date restrictions will limit the review to studies published after 2010 and those in English during the study selection process. We will use the modified Drummond checklist to evaluate the quality of each included study. Our findings will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement. A summary will include estimated costs, effectiveness, benefits, and the incremental cost-effectiveness ratio (ICER). We also plan to conduct a subgroup analysis. To aid comparability, we will standardise all costs to the United States Dollar, adjusting them to their 2022 value using country-specific consumer price index and purchasing power parity.Ethics and disseminationThis systematic review will not involve human participants and requires no ethical approval. We will publish the results in a peer-reviewed journal.Trial registrationWe registered our record on PROSPERO (registration #: CRD42023432232).
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- 2024
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11. Tending to the machine: The impact of intrapartum fetal surveillance on women in Australia.
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Deborah Fox, Rebecca Coddington, Kate M Levett, Vanessa Scarf, Kerry L Sutcliffe, and Elizabeth Newnham
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Medicine ,Science - Abstract
Qualitative research about women and birthing people's experiences of fetal monitoring during labour and birth is scant. Labour and birth is often impacted by wearable or invasive monitoring devices, however, most published research about fetal monitoring is focused on the wellbeing of the fetus. This manuscript is derived from a larger mixed methods study, 'WOmen's Experiences of Monitoring Baby (The WOMB Study)', aiming to increase understanding of the experiences of women and birthing people in Australia, of being monitored; and about the information they received about fetal monitoring devices during pregnancy. We constructed a national cross-sectional survey that was distributed via social media in May and June, 2022. Responses were received from 861 participants. As far as we are aware, this is the first survey of the experiences of women and birthing people of intrapartum fetal monitoring conducted in Australia. This paper comprises the analysis of the free text survey responses, using qualitative and inductive content analysis. Two categories were constructed, Tending to the machine, which explores participants' perceptions of the way in which clinicians interacted with fetal monitoring technologies; and Impressions of the machine, which explores the direct impact of fetal monitoring devices upon the labour and birth experience of women and birthing people. The findings suggest that some clinicians need to reflect upon the information they provide to women and birthing people about monitoring. For example, freedom of movement is an important aspect of supporting the physiology of labour and managing pain. If freedom of movement is important, the physical restriction created by a wired cardiotocograph is inappropriate. Many participants noticed that clinicians focused their attention primarily on the technology. Prioritising the individual needs of the woman or birthing person is key to providing high quality woman-centred intrapartum care. Women should be provided with adequate information regarding the risks and benefits of different forms of fetal monitoring including how the form of monitoring might impact her labour experience.
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- 2024
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12. Somatophilic Rationality for Reproductive Justice
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Rodante van der Waal, Inge van Nistelrooij, Deborah Fox, and Elizabeth Newnham
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Shulamith Firestone ,Reproductive technology ,Midwifery ,Reproductive justice ,Medicalisation of birth ,Biological materialism ,Philosophy (General) ,B1-5802 ,Technology - Abstract
A dominant strand of second wave feminism, represented in this essay by Firestone, is tied to a belief in technology to achieve reproductive justice, echoing Western somatophobic rationality. As such, it has difficulty formulating a critique of institutionalized reproductive technologies that have the capacity to perpetuate systemic racializing and misogynous violence, and envisioning a philosophy of reproductive justice where care for the body takes central stage. In this essay, we offer a perspective on achieving reproductive justice from an age-old position largely neglected by feminism: that of midwifery. Midwifery has always been wary of technology in the field of reproduction, having first-hand experience with its consequences in birth and pregnancy, and has developed a field of scholarship critiquing its misuse. Simultaneously, midwifery negotiates technology from a position that prioritizes experiential, embodied, and tacit knowledge. Midwifery’s epistemological standpoint is that of a somatophilic rationality of thinking with the body, guarding women and birthing people’s reproductive autonomy through a specific technē that uses both technology and nature. A certain tendency in midwifery is, however, developing more and more towards an anti-technological essentialism. This essay therefore brings into dialogue Firestone’s Marxist women’s liberation through the elimination of biological sex with the help of technology, and midwifery’s somatophilic epistemic standpoint, to develop a feminist rational engagement with nature that can achieve reproductive justice, on the basis of their shared biological materialism.
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- 2024
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13. The Australian Mainstream Media’s Portrayal of Youth Climate Activism and Dissent
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Jacob Micah Cowan, Peta Dzidic, and Elizabeth Newnham
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climate change ,climate activism ,youth activism ,media framing ,dissent ,active citizenship ,Sociology (General) ,HM401-1281 - Abstract
The March 2019 School Strikes 4 Climate, predominantly organized by young students, garnered widespread and polarizing media coverage. We aimed to identify how Australian mainstream print news media portrays youth involvement and dissent within climate action movements. A qualitative media framing analysis was conducted to determine how youth climate activists and dissent were presented during the first large-scale youth climate protests in Australia. Australian newspaper articles and opinion pieces (N = 101) were identified via ProQuest and screened. An inductive thematic analysis was conducted in NVivo12. Findings were assessed through a typology of dissent to determine how different forms of dissent were represented in the Australian print news media. The framing of dissent in Australian media coverage was varied, with news articles being more likely to prioritize the voices of young people, while opinion pieces resorted to fear-mongering rhetoric that critiqued and invalidated their agency. Protestors used combinations of dutiful and disruptive dissent to advocate for climate action, with the latter being more effective for challenging systemic drivers of climate change.
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- 2023
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14. Positive postpartum well‐being: What works for women
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Susan Hannon, Elizabeth Newnham, Kathleen Hannon, Francesca Wuytack, Louise Johnson, Ellen McEvoy, and Déirdre Daly
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maternal health ,postnatal ,postpartum period ,qualitative research ,salutogenesis ,well‐being ,Medicine (General) ,R5-920 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Women's experiences of pregnancy, birth and motherhood extend beyond healthcare provision and the immediate postpartum. Women's social, cultural and political environments shape the positive or negative effects of their experiences through this transition. However, there is limited research concerning the factors that women identify as being protective or promotive of maternal well‐being in the perinatal period and motherhood transition. Objective To explore women's views on the factors within healthcare, social, cultural, organizational, environmental and political domains that do or can work well in creating positive perinatal experiences. Design, Setting and Participants A qualitative descriptive study with embedded public and participant involvement (PPI). Participants were 24 women who were maternity care service users giving birth in Ireland. Results Three themes were developed. The first theme, ‘tone of care’, related to women's interactions with and attitudes of healthcare professionals in setting the tone for the care they experienced. The second theme, ‘postpartum presence and support’, concerned the professional postpartum supports and services that women found beneficial in the motherhood transition. The final theme, ‘flexibility for new families’ addresses social and organizational issues around parents returning to paid employment. Discussion and Conclusion Women suggested multiple avenues for promoting positive perinatal experiences for women giving birth in Ireland, which may be implemented at healthcare and policy levels. Women identified that maternal health education focuses on supporting informed decision‐making processes as a positive and worry‐alleviating resource. Additionally, women valued being met by healthcare professionals who regard women as the decision makers in their care experience. Exchanges in which healthcare professionals validate and encourage women in their mothering role and actively involve their partners as caregivers left lasting positive impressions. Extended and professional postpartum support was a common issue, and phone lines or drop‐in clinics were suggested as invaluable and affirming assets where women could access personalized support with healthcare professionals who had the knowledge and skills to genuinely approach women's concerns. Social and organizational considerations involved supporting parents to balance their responsibilities as new or growing families in the return to work. Public or Patient Contribution Maternity care service users were involved in the interviews and manuscript preparation.
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- 2022
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15. Influences on the physical and mental health of people with serious mental ill-health during the COVID-19 pandemic: a qualitative interview study
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Elizabeth Newbronner, Lauren Walker, Ruth Wadman, Suzanne Crosland, Gordon Johnston, Paul Heron, Panagiotis Spanakis, Simon Gilbody, and Emily Peckham
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severe mental ill-health (smi) ,mental health ,physical health ,covid-19 pandemic ,qualitative research ,interview study ,Medicine (General) ,R5-920 - Abstract
Purpose People with severe mental ill-health (SMI) experience profound health inequalities. The Optimizing Wellbeing in Self-isolation study (OWLS) explored the effects of the COVID-19 pandemic restrictions on people with SMI, including how and why their physical and mental health may have changed during the pandemic. Methods The OLWS study comprised two surveys and two nested qualitative studies. Of 367 people recruited to the study, 235 expressed interest in taking part in a qualitative interview. In the first qualitative study eighteen interviews were conducted with a purposive sample of participants. Results We identified six factors which influenced peoples’ health, positively and negatively: Staying Physically Active; Maintaining a Balanced and Healthy Diet; Work or Not Working; Daily Routine and Good Sleep; Staying Connected to Family, Friends and the Local Community; and Habits, Addictions and Coping with Anxiety Created by the Pandemic. Conclusions Different aspects of lifestyle are highly interconnected. For people with SMI, loss of routine and good sleep, poor diet and lack of exercise can compound each other, leading to a decline in physical and mental health. If people are supported to understand what helps them stay well, they can establish their own frameworks to draw on during difficult times.
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- 2022
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16. Sleep health among people with severe mental ill health during the COVID-19 pandemic: Results from a linked UK population cohort study
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Paul N. Heron, Lisa M. Henderson, Suzanne Crosland, Simon M. Gilbody, Gordon A. Johnston, Andrew S. Moriarty, Elizabeth Newbronner, Alastair Paterson, Panagiotis Spanakis, Ruth Wadman, Lauren Walker, and Emily Peckham
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sleep ,severe mental ill health (SMI) ,bipolar disorder ,psychosis ,schizophrenia ,wellbeing ,Psychiatry ,RC435-571 - Abstract
ObjectivesSleep problems are a transdiagnostic feature of nearly all psychiatric conditions, and a strong risk factor for initial and recurrent episodes. However, people with severe mental ill health (SMI) are often excluded from general population surveys, and as such the extent and associates of poor sleep in this population are less well understood. This study explores sleep health in an SMI sample during the COVID-19 pandemic, using multiple regression to identify risk factors, including daily routine, wellbeing and demographics.MethodsAn existing cohort of people with an SMI diagnosis were sampled. Participants were invited to complete a self-report survey about their health and the impacts of COVID-19 and associated public health measures. Sleep duration, efficiency, and quality were measured using items from the Pittsburgh Sleep Quality Index (PSQI).ResultsTwo hundred forty-nine adults (aged 21–84 years) completed the survey. Mean sleep duration and efficiency were similar to general population estimates, at 7 h 19 min and 78%, respectively. However, 43% reported “bad” sleep quality that was associated with being younger in age as well as disturbed routine and declined wellbeing. Indeed, 37% reported a disturbed routine during the pandemic.ConclusionsHigh estimates of perceived poor sleep quality in the SMI population align with previous findings. Supporting people with SMI to maintain routine regularity may work to protect sleep quality and wellbeing. Future research should more closely examine sleep health in people with SMI, using accessible and scalable measures of objective and subjective sleep, examining longitudinal trends.
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- 2022
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17. Compassion Focused Group Therapy for People With a Diagnosis of Bipolar Affective Disorder: A Feasibility Study
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Paul Gilbert, Jaskaran K. Basran, Joanne Raven, Hannah Gilbert, Nicola Petrocchi, Simone Cheli, Andrew Rayner, Alison Hayes, Kate Lucre, Paschalina Minou, David Giles, Frances Byrne, Elizabeth Newton, and Kirsten McEwan
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bipolar ,compassion focused therapy ,competitiveness ,heart rate variability ,biopsychosocial ,caring ,Psychology ,BF1-990 - Abstract
BackgroundCompassion focused therapy (CFT) is an evolutionary informed, biopsychosocial approach to mental health problems and therapy. It suggests that evolved motives (e.g., for caring, cooperating, competing) are major sources for the organisation of psychophysiological processes which underpin mental health problems. Hence, evolved motives can be targets for psychotherapy. People with certain types of depression are psychophysiologically orientated towards social competition and concerned with social status and social rank. These can give rise to down rank-focused forms of social comparison, sense of inferiority, worthlessness, lowered confidence, submissive behaviour, shame proneness and self-criticism. People with bipolar disorders also experience elevated aspects of competitiveness and up rank status evaluation. These shift processing to a sense of superiority, elevated confidence, energised behaviour, positive affect and social dominance. This is the first study to explore the feasibility of a 12 module CFT group, tailored to helping people with a diagnosis of bipolar disorder understand the impact of evolved competitive, status-regulating motivation on their mental states and the value of cultivating caring and compassion motives and their psychophysiological regulators.MethodsSix participants with a history of bipolar disorder took part in a CFT group consisting of 12 modules (over 25 sessions) as co-collaborators to explore their personal experiences of CFT and potential processes of change. Assessment of change was measured via self-report, heart rate variability (HRV) and focus groups over three time points.ResultsAlthough changes in self-report scales between participants and across time were uneven, four of the six participants consistently showed improvements across the majority of self-report measures. Heart rate variability measures revealed significant improvement over the course of the therapy. Qualitative data from three focus groups revealed participants found CFT gave them helpful insight into: how evolution has given rise to a number of difficult problems for emotion regulation (called tricky brain) which is not one’s fault; an evolutionary understanding of the nature of bipolar disorders; development of a compassionate mind and practices of compassion focused visualisations, styles of thinking and behaviours; addressing issues of self-criticism; and building a sense of a compassionate identity as a means of coping with life difficulties. These impacted their emotional regulation and social relationships.ConclusionAlthough small, the study provides evidence of feasibility, acceptability and engagement with CFT. Focus group analysis revealed that participants were able to switch from competitive focused to compassion focused processing with consequent improvements in mental states and social behaviour. Participants indicated a journey over time from ‘intellectually’ understanding the process of building a compassionate mind to experiencing a more embodied sense of compassion that had significant impacts on their orientation to (and working with) the psychophysiological processes of bipolar disorder.
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- 2022
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18. A psychological intervention by community pharmacies to prevent depression in adults with subthreshold depression and long-term conditions: the CHEMIST pilot RCT
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Elizabeth Littlewood, Carolyn A Chew-Graham, Elizabeth Coleman, Samantha Gascoyne, Claire Sloan, Shehzad Ali, Jay Badenhorst, Della Bailey, Suzanne Crosland, Charlotte EW Kitchen, Dean McMillan, Caroline Pearson, Adam Todd, Cate Whittlesea, Clare Bambra, Catherine Hewitt, Claire Jones, Ada Keding, Elizabeth Newbronner, Alastair Paterson, Shelley Rhodes, Eloise Ryde, Paul Toner, Michelle Watson, Simon Gilbody, and David Ekers
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subthreshold depression ,long-term conditions ,community pharmacy ,enhanced support intervention ,behavioural activation ,collaborative care ,multimorbidity ,public health intervention ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Depression is common in people with long-term health conditions, and this combination can lead to worsened health outcomes and increased health-care costs. Subthreshold depression, a risk factor for major depression, is prevalent in this population, but many people remain untreated due to the demand on services. The community pharmacy may be an alternative setting to offer mental health support; however, insufficient evidence exists to support implementation. Objectives: To conduct a feasibility study and pilot randomised controlled trial of a community pharmacy-delivered psychological intervention aimed at preventing depression in adults with long-term health conditions. Design: A feasibility study with nested qualitative evaluation and an external pilot, two-arm, 1 : 1 individually randomised controlled trial with nested process and economic evaluations. Setting: Community pharmacies in the north of England. Participants: Adults aged ≥ 18 years with subthreshold depression and at least one long-term health condition. Intervention: A bespoke enhanced support intervention (behavioural activation within a collaborative care framework) involving up to six sessions delivered by trained community pharmacy staff (intervention facilitators) compared with usual care. Main outcome measures: Recruitment and retention rates, completeness of outcome measures and intervention engagement. The intended primary outcome was depression severity at 4 months, assessed by the Patient Health Questionnaire-9. Results: In the feasibility study, 24 participants were recruited. Outcome measure completeness was 95–100%. Retention at 4 months was 83%. Seventeen participants (71%) commenced intervention sessions and all completed two or more sessions. Depression symptoms reduced slightly at 4 months. The process evaluation suggested that the intervention was acceptable to participants and intervention facilitators. In the pilot randomised controlled trial, 44 participants (target of 100 participants) were randomised (intervention, n = 24; usual care, n = 20). Outcome measure completeness was 100%. Retention at 4 months was 93%. Eighteen participants (75%) commenced intervention sessions and 16 completed two or more sessions. Depression symptoms reduced slightly at 4 months, with a slightly larger reduction in the usual-care arm, although the small sample size limits any conclusions. The process evaluation reported good acceptability of the intervention and identified barriers associated with study implementation and its impact on core pharmacy functions. The economic analysis revealed some indication of reduced resource use/costs associated with the intervention, but this is limited by the small sample size. Intervention costs were low. Limitations: The main limitation is the small sample size due to difficulties with recruitment and barriers to implementing the study within existing pharmacy practices. Conclusions: The community pharmacy represents a new setting to deliver a depression prevention intervention. Recruitment was a challenge and pharmacy staff encountered barriers to effective implementation of the study within busy pharmacy practice. Despite these challenges, good retention rates and intervention engagement were demonstrated, and process evaluation suggested that the intervention was acceptable in this setting. To the best of our knowledge, this is the first study to demonstrate that community pharmacy staff can be trained to deliver a depression prevention intervention. Future work: Further work is needed to address barriers to recruitment, intervention delivery and implementation of psychological interventions in the community pharmacy setting. Trial registration: This trial is registered as ISRCTN11290592. Funding: This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 5. See the NIHR Journals Library website for further project information.
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- 2022
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19. Exploring Access to Mental Health and Primary Care Services for People With Severe Mental Illness During the COVID-19 Restrictions
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Elizabeth Newbronner, Panagiotis Spanakis, Ruth Wadman, Suzanne Crosland, Paul Heron, Gordon Johnston, Lauren Walker, Simon Gilbody, and Emily Peckham
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health services ,severe mental ill health ,schizoaffecfive disorder ,schizophrenia ,bipolar disorder ,COVID-19 ,Psychiatry ,RC435-571 - Abstract
AimsTo explore: how satisfied people with severe mental illness (SMI) are with the support received during the pandemic; understand any difficulties encountered when accessing both mental health and primary care services; consider ways to mitigate these difficulties; and assess the perceived need for future support from mental health services.Materials and MethodsA representative sample was drawn from a large transdiagnostic clinical cohort of people with SMI, which was recruited between April 2016 and March 2020. The sample was re-surveyed a few months after the beginning of the restrictions. Descriptive frequency statistics were used to analyze the quantitative data. The free text responses were analyzed thematically.Results367 participants responded to the survey. Two thirds were receiving support from mental health services with the rest supported in primary care or self-managing. A quarter thought they would need more mental health support in the coming year. Half had needed to used community mental health services during the pandemic and the majority had been able to get support. A minority reported that their mental health had deteriorated but they had either not got the supported they wanted or had not sought help. The biggest service change was the reduction in face-to-face appointments and increasing use of phone and video call support. Nearly half of those using mental health services found this change acceptable or even preferred it. However, acceptability was influenced by several factors, and participants were more likely to report that they had received all the support they needed, when seen in person.DiscussionAlthough most participants were satisfied with the mental health support they had received, a minority were not. This, couple with findings on future need for mental health support has implications for post pandemic demand on services. Remote care has brought benefits but also risks that it could increase inequalities in access to services.
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- 2022
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20. A Year Into the Pandemic: The Diversity of Experience Amongst People With Severe Mental Ill Health
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Emily Peckham, Panagiotis Spanakis, Paul Heron, Suzanne Crosland, Gordon Johnston, Elizabeth Newbronner, Ruth Wadman, Lauren Walker, and Simon Gilbody
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schizophrenia ,bipolar disorder ,severe mental ill health ,COVID-19 ,health risk behavior ,inequalities ,Psychiatry ,RC435-571 - Abstract
BackgroundThe COVID-19 pandemic has amplified pre-existing health inequalities and people with severe mental ill health (SMI) are one of the groups at greatest risk. In this study, we explored the effects of the pandemic and pandemic restrictions on people with SMI during the first year of the pandemic.MethodsWe conducted a longitudinal study in a sample of people with SMI. The inception survey was carried out between July and December 2020. Participants were then re-surveyed between January and March 2021. People were contacted by telephone and invited to take part in the study over the phone, online or by postal questionnaire. Across both waves we asked participants about their physical and mental health, health risk behaviors, well-being, loneliness, and employment status.ResultsThree hundred and sixty-seven people with SMI completed the inception survey and 249 people completed the follow up. Whilst some people reported no change in their physical (77, 31%) or mental health (60, 24%) over the course of the pandemic 53 (21%) reported a continuing decline in physical health and 52 (21%) reported a continuing decline in mental health. Participants who maintained a daily routine or reported no decline in physical health were found to be associated with no deterioration in mental health (Daily routine OR 2.27, 95% CI 1.11–4.64; no reported physical health decline OR 0.54, 95% CI 0.17–0.70). Participants were less likely to be occupationally active in the first phase of the pandemic compared to before the pandemic and in the second phase of the pandemic. However, there was no one single experience of people with SMI and similar to studies in the general populations a range of different scenarios was experienced.ConclusionsWe observed a series of factors that might amplify pre-existing health inequalities. Health systems should be mindful of this, and should redouble efforts to set in place changes to practice and policy, which can mitigate these inequalities. Examples might include; raising awareness of the importance of ensuring that people with SMI receive an annual physical health check and supporting people to maintain a daily routine.
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- 2022
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21. Loneliness among people with severe mental illness during the COVID-19 pandemic: Results from a linked UK population cohort study.
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Paul Heron, Panagiotis Spanakis, Suzanne Crosland, Gordon Johnston, Elizabeth Newbronner, Ruth Wadman, Lauren Walker, Simon Gilbody, and Emily Peckham
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Medicine ,Science - Abstract
Aim/goal/purposePopulation surveys underrepresent people with severe mental ill health. This paper aims to use multiple regression analyses to explore perceived social support, loneliness and factor associations from self-report survey data collected during the Covid-19 pandemic in a sample of individuals with severe mental ill health.Design/methodology/approachWe sampled an already existing cohort of people with severe mental ill health. Researchers contacted participants by phone or by post to invite them to take part in a survey about how the pandemic restrictions had impacted health, Covid-19 experiences, perceived social support, employment and loneliness. Loneliness was measured by the three item UCLA loneliness scale.FindingsIn the pandemic sub-cohort, 367 adults with a severe mental ill health diagnosis completed a remote survey. 29-34% of participants reported being lonely. Loneliness was associated with being younger in age (adjusted OR = -.98, p = .02), living alone (adjusted OR = 2.04, p = .01), high levels of social and economic deprivation (adjusted OR = 2.49, p = .04), and lower perceived social support (B = -5.86, p < .001). Living alone was associated with lower perceived social support. Being lonely was associated with a self-reported deterioration in mental health during the pandemic (adjusted OR = 3.46, 95%CI 2.03-5.91).Practical implicationsIntervention strategies to tackle loneliness in the severe mental ill health population are needed. Further research is needed to follow-up the severe mental ill health population after pandemic restrictions are lifted to understand perceived social support and loneliness trends.OriginalityLoneliness was a substantial problem for the severe mental ill health population before the Covid-19 pandemic but there is limited evidence to understand perceived social support and loneliness trends during the pandemic.
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- 2022
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22. Behavioural Activation for Social IsoLation (BASIL+) trial (Behavioural activation to mitigate depression and loneliness among older people with long-term conditions): Protocol for a fully-powered pragmatic randomised controlled trial.
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Lauren Burke, Elizabeth Littlewood, Samantha Gascoyne, Dean McMillan, Carolyn A Chew-Graham, Della Bailey, Claire Sloan, Caroline Fairhurst, Kalpita Baird, Catherine Hewitt, Andrew Henry, Eloise Ryde, Leanne Shearsmith, Peter Coventry, Suzanne Crosland, Elizabeth Newbronner, Gemma Traviss-Turner, Rebecca Woodhouse, Andrew Clegg, Tom Gentry, Andrew Hill, Karina Lovell, Sarah Dexter Smith, Judith Webster, David Ekers, and Simon Gilbody
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Medicine ,Science - Abstract
IntroductionDepression is a leading mental health problem worldwide. People with long-term conditions are at increased risk of experiencing depression. The COVID-19 pandemic led to strict social restrictions being imposed across the UK population. Social isolation can have negative consequences on the physical and mental wellbeing of older adults. In the Behavioural Activation in Social IsoLation (BASIL+) trial we will test whether a brief psychological intervention (based on Behavioural Activation), delivered remotely, can mitigate depression and loneliness in older adults with long-term conditions during isolation.MethodsWe will conduct a two-arm, parallel-group, randomised controlled trial across several research sites, to evaluate the clinical and cost-effectiveness of the BASIL+ intervention. Participants will be recruited via participating general practices across England and Wales. Participants must be aged ≥65 with two or more long-term conditions, or a condition that may indicate they are within a 'clinically extremely vulnerable' group in relation to COVID-19, and have scored ≥5 on the Patient Health Questionnaire (PHQ9), to be eligible for inclusion. Randomisation will be 1:1, stratified by research site. Intervention participants will receive up to eight intervention sessions delivered remotely by trained BASIL+ Support Workers and supported by a self-help booklet. Control participants will receive usual care, with additional signposting to reputable sources of self-help and information, including advice on keeping mentally and physically well. A qualitative process evaluation will also be undertaken to explore the acceptability of the BASIL+ intervention, as well as barriers and enablers to integrating the intervention into participants' existing health and care support, and the impact of the intervention on participants' mood and general wellbeing in the context of the COVID-19 restrictions. Semi-structured interviews will be conducted with intervention participants, participant's caregivers/supportive others and BASIL+ Support Workers. Outcome data will be collected at one, three, and 12 months post-randomisation. Clinical and cost-effectiveness will be evaluated. The primary outcome is depressive symptoms at the three-month follow up, measured by the PHQ9. Secondary outcomes include loneliness, social isolation, anxiety, quality of life, and a bespoke health services use questionnaire.DiscussionThis study is the first large-scale trial evaluating a brief Behavioural Activation intervention in this population, and builds upon the results of a successful external pilot trial.Trial registrationClinicalTrials.Gov identifier ISRCTN63034289, registered on 5th February 2021.
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- 2022
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23. Electroconvulsive therapy for the acute management of severe agitation in dementia (ECT-AD): A modified study protocol.
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Lapid MI, Merrill J, Mueller M, Hermida AP, Nykamp L, Andrus J, Azizi H, Bolton P, Bonsu N, Braga R, Dillon CR, Ecklesdafer D, Evans D, Harper D, Heintz H, Hussain-Krauter S, Holzgen O, Humphrey D, Jiwani S, Johnson EK, Kang S, Kassien J, Kim J, Knapp RG, Kung S, Kremen N, Le K, Mahdasian J, Marzouk T, Masrud JD, Mattingly J, Miller D, Pagali SR, Patrick R, Riva Posse P, Pritchett C, Rahman A, Rath S, Roczniak C, Rummans TA, Sanghani S, Seiner S, Smart L, Tomaschek E, Tsygankova V, VanderSchuur-White L, Walton MP, Wilkins J, Williams A, Williams SM, Petrides G, and Forester BP
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- Humans, Single-Blind Method, Female, Male, Treatment Outcome, Aged, Aberrant Motor Behavior in Dementia, Electroconvulsive Therapy methods, Psychomotor Agitation therapy, Dementia therapy, Dementia complications
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Objective: This study began as a single-blind randomized controlled trial (RCT) to investigate the efficacy and safety of electroconvulsive therapy (ECT) for severe treatment-refractory agitation in advanced dementia. The aims are to assess agitation reduction using the Cohen-Mansfield Agitation Inventory (CMAI), evaluate tolerability and safety outcomes, and explore the long-term stability of agitation reduction and global functioning. Due to challenges encountered during implementation, including recruitment obstacles and operational difficulties, the study design was modified to an open-label format and other protocol amendments were implemented., Methods: Initially, the RCT randomized participants 1:1 to either ECT plus usual care or simulated ECT plus usual care (S-ECT) groups. As patients were enrolled, data were collected from both ECT and simulated ECT (S-ECT) patients. The study now continues in an open-label study design where all patients receive actual ECT, reducing the targeted sample size from 200 to 50 participants., Results: Study is ongoing and open to enrollment., Conclusion: The transition of the ECT-AD study design from an RCT to open-label design exemplifies adaptive research methodologies in response to real-world challenges. Data from both the RCT and open-label phases of the study will provide a unique perspective on the role of ECT in managing severe treatment-refractory agitation in dementia, potentially influencing future clinical practices and research approaches., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lapid et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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24. Smoking behaviors among Middle Eastern college women in the United States.
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Kozachek CC and Btoush RM
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Objective: to examine factors associated with cigarette and hookah smoking among Middle Eastern (ME) Arab college women. Participants: 406 adult women of ME Arabic background, currently enrolled in or recently graduated from a US college. Methods: a cross-sectional design, using an anonymous online survey of demographic characteristics, sociocultural factors, and access to health care factors. Data analysis included regression model to identify predictors of smoking behaviors. Results: Smoking rates were 21% and 19% for cigarette and hookah smoking. Cigarette smoking was higher with having liberal attitudes toward sexuality and lower among those having a healthcare provider. Hookah smoking was higher among students who are Muslim, involved in student organizations, have higher acculturation-heritage levels, and have more liberal attitudes toward women. Hookah smoking was lower among students born in the US, attending college part-time, and having higher religiosity levels. Conclusions: The study findings have several implications for interventions to address smoking behaviors among ME Arab college women through community organizations and within college campuses.
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- 2024
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25. Defining the pathway to timely diagnosis and treatment of interstitial lung disease: a US Delphi survey.
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Case AH, Beegle S, Hotchkin DL, Kaelin T, Kim HJ, Podolanczuk AJ, Ramaswamy M, Remolina C, Salvatore MM, Tu C, and de Andrade JA
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- Humans, Comorbidity, Surveys and Questionnaires, Diagnostic Errors, Lung Diseases, Interstitial diagnosis, Lung Diseases, Interstitial therapy, Physicians
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Introduction: Timely diagnosis of interstitial lung disease (ILD) is limited by obstacles in the current patient pathway. Misdiagnosis and delays are common and may lead to a significant burden of diagnostic procedures and worse outcomes. This Delphi survey aimed to identify consensus on the key steps that facilitate the patient journey to an accurate ILD diagnosis and appropriate management in the US., Methods: A modified Delphi analysis was conducted, comprising three online surveys based on a comprehensive literature search. The surveys spanned five domains (guidelines, community screening, diagnosis, management and specialist referral) and were completed by a panel of US physicians, including primary care physicians and pulmonologists practising in community or academic settings. A priori definitions of consensus agreement were median scores of 2-3 (agree strongly/agree), with an IQR of 0-1 for questions on a 7-point Likert scale from -3 to 3, or ≥80% agreement for binary questions., Results: Forty-nine panellists completed the surveys and 62 statements reached consensus agreement. There was consensus agreement on what should be included in the primary care evaluation of patients with suspected ILD and the next steps following workup. Regarding diagnosis in community pulmonology care, consensus agreement was reached on the requisition and reporting of high-resolution CT scans and the appropriate circumstances for holding multidisciplinary discussions. Additionally, there was consensus agreement on which symptoms and comorbidities should be monitored, the frequency of consultations and the assessment of disease progression. Regarding specialist referral, consensus agreement was reached on which patients should receive priority access to ILD centres and the contents of the referral package., Conclusions: These findings clarify the most common issues that should merit further evaluation for ILD and help define the steps for timely, accurate diagnosis and appropriate collaborative specialty management of patients with ILD., Competing Interests: Competing interests: AHC reports receiving research contracts from Boehringer Ingelheim, Roche-Genentech, United Therapeutics, Fibrogen, Veracyte, Galapagos, Pilant, Kadmon, Bristol Myers Squibb, Bellerophon Therapeutics, Pulmonary Fibrosis Foundation (PFF) and Galecto; consulting fees from Veracyte; speaker fees from Boehringer Ingelheim, Genentech, The France Foundation and Paradigm Medical; medical writing support from Boehringer Ingelheim, Veracyte and United Therapeutics; and reports involvement at the PFF as a Senior Medical Advisor, outside the submitted work. SB reports receiving speaker fees from Boehringer Ingelheim, outside the submitted work. DLH reports receiving clinical research grants from Boehringer Ingelheim, Galapagos, Bellerophon Therapeutics and Fibrogen, outside the submitted work. TK reports receiving speaker fees from Boehringer Ingelheim, outside the submitted work. HJK has nothing to disclose. AJP reports receiving grants from the American Lung Association and the National Heart, Lung and Blood Institute (NHLBI); consulting fees from Regeneron, Roche and Imvaria; speaker fees from the National Association for Continuing Education and DynaMed; and reports involvement in a Boehringer Ingelheim advisory board, outside the submitted work. MR reports involvement in a Boehringer Ingelheim advisory board, outside the submitted work. CR reports receiving speaker fees from Boehringer Ingelheim, outside the submitted work. MMS reports receiving grants, consulting fees and speaker fees from Boehringer Ingelheim and Genentech, outside the submitted work. CT reports receiving speaker fees from AstraZeneca, outside the submitted work. JAdA reports receiving speaker fees from Boehringer Ingelheim; participation on Data Safety Monitoring Boards for Respivant, Roche-Genentech and NHLBI; and involvement in the PFF as a Scientific Advisory Committee member, outside the submitted work., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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26. A Study on QT Dispersion before and after Thrombolysis in Acute Myocardial Infarction and its Prognostic Implications: A before and after Comparison Study.
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M A, Khandait H, Guralwar C, Khandait V, Mahajan R, and Atkar C
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- Humans, Male, Female, Middle Aged, Prognosis, ST Elevation Myocardial Infarction physiopathology, Aged, Fibrinolytic Agents therapeutic use, India epidemiology, Myocardial Infarction physiopathology, Myocardial Infarction drug therapy, Thrombolytic Therapy methods, Electrocardiography
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Introduction : Acute myocardial infarction (AMI) stands as one of the most catastrophic occurrences in the progression of coronary artery disease. Measuring QT dispersion (QTd) is a fairly straightforward and noninvasive technique for predicting mortality in patients at high risk following a myocardial infarction (MI). Objective : To measure the QT, corrected QT interval (QTc), QTd, and corrected QT dispersion (QTcd) intervals before and after thrombolysis in patients with AMI and to determine prognostic implications of QTd in AMI. Materials and methods : This was a before and after comparison study conducted in the intensive care unit (ICU) of a tertiary care center in Central India. It was carried out in patients with AMI [ST-elevation myocardial infarction (STEMI)] who underwent thrombolysis in ICU. A total of 160 participants were enrolled over the time period of 24 months using the convenience sampling technique. Results : The most prevalent (68 patients) risk factor among MI patients was hypertension (HTN). QT parameters such as QT, QTd, and QTcd showed significant statistical variation of p -value < 0.0001 when compared at admission and after thrombolysis. No significant difference ( p > 0.05) in QT parameters at admission (QTd, QTc, and QTcd) between anterior and inferior wall MI, except for QT interval ( p = 0.0010). Among the 33 patients who experienced arrhythmia, ventricular tachycardia was the most prevalent arrhythmia in 22 patients (13.75%). There was a significant statistical correlation between the arrhythmic event and the outcome of the patient ( p < 0.0001). Patients who died had higher QT parameter values at admission, and these remained on the higher side even after thrombolysis, whereas those who got discharged had lower QT parameter values at admission, and their values decreased after thrombolysis. Conclusion : Successful thrombolysis significantly decreases the QTd and thereby the arrhythmogenic potential, and thus can also be used as a reliable predictor of arrhythmia in patients of MI. How to cite this article : M A, Khandait H, Guralwar C, et al. A Study on QT Dispersion before and after Thrombolysis in Acute Myocardial Infarction and its Prognostic Implications: A before and after Comparison Study. J Assoc Physicians India 2023;71(10):14-18., (© Journal of the Association of Physicians of India 2023.)
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- 2023
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27. A Case of Liquorice-Infused Marijuana Causing Syndrome of Apparent Mineralocorticoid Excess.
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Latif A, Naqi M, and McAnally JF
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Marijuana has long been used both for recreational and medicinal purposes. Most of the available forms of marijuana contain additives such as liquorice to enhance its flavour. Liquorice increases the amounts of cortisol in the body and produces metabolic abnormalities seen in primary hyperaldosteronism
[1] . Liquorice extracts are mixed with marijuana in the same way as for tobacco[2,3] . We describe a case of apparent mineralocorticoid excess due to excessive smoking of liquorice-laced marijuana. To our knowledge, this is the first reported case of apparent mineralocorticoid excess caused by marijuana use., Learning Points: First report of liquorice-laced marijuana causing syndrome of apparent mineralocorticoid excess (SAME).Since its legalisation, marijuana is reported to be the most used substance second only to alcohol. With the increased availability of marijuana, the health care providers and consumers must be cognisant of its side effects.It is a dose-dependent phenomenon. The effects vary from minor clinical symptoms to fatal arrhythmias based on the amount consumed., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2023.)- Published
- 2023
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28. Abatacept, Cenicriviroc, or Infliximab for Treatment of Adults Hospitalized With COVID-19 Pneumonia: A Randomized Clinical Trial.
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O'Halloran JA, Ko ER, Anstrom KJ, Kedar E, McCarthy MW, Panettieri RA Jr, Maillo M, Nunez PS, Lachiewicz AM, Gonzalez C, Smith PB, de Tai SM, Khan A, Lora AJM, Salathe M, Capo G, Gonzalez DR, Patterson TF, Palma C, Ariza H, Lima MP, Blamoun J, Nannini EC, Sprinz E, Mykietiuk A, Alicic R, Rauseo AM, Wolfe CR, Witting B, Wang JP, Parra-Rodriguez L, Der T, Willsey K, Wen J, Silverstein A, O'Brien SM, Al-Khalidi HR, Maldonado MA, Melsheimer R, Ferguson WG, McNulty SE, Zakroysky P, Halabi S, Benjamin DK Jr, Butler S, Atkinson JC, Adam SJ, Chang S, LaVange L, Proschan M, Bozzette SA, and Powderly WG
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- Male, Humans, Adult, Middle Aged, Female, Abatacept, Infliximab, SARS-CoV-2, Pandemics, COVID-19
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Importance: Immune dysregulation contributes to poorer outcomes in COVID-19., Objective: To investigate whether abatacept, cenicriviroc, or infliximab provides benefit when added to standard care for COVID-19 pneumonia., Design, Setting, and Participants: Randomized, double-masked, placebo-controlled clinical trial using a master protocol to investigate immunomodulators added to standard care for treatment of participants hospitalized with COVID-19 pneumonia. The results of 3 substudies are reported from 95 hospitals at 85 clinical research sites in the US and Latin America. Hospitalized patients 18 years or older with confirmed SARS-CoV-2 infection within 14 days and evidence of pulmonary involvement underwent randomization between October 2020 and December 2021., Interventions: Single infusion of abatacept (10 mg/kg; maximum dose, 1000 mg) or infliximab (5 mg/kg) or a 28-day oral course of cenicriviroc (300-mg loading dose followed by 150 mg twice per day)., Main Outcomes and Measures: The primary outcome was time to recovery by day 28 evaluated using an 8-point ordinal scale (higher scores indicate better health). Recovery was defined as the first day the participant scored at least 6 on the ordinal scale., Results: Of the 1971 participants randomized across the 3 substudies, the mean (SD) age was 54.8 (14.6) years and 1218 (61.8%) were men. The primary end point of time to recovery from COVID-19 pneumonia was not significantly different for abatacept (recovery rate ratio [RRR], 1.12 [95% CI, 0.98-1.28]; P = .09), cenicriviroc (RRR, 1.01 [95% CI, 0.86-1.18]; P = .94), or infliximab (RRR, 1.12 [95% CI, 0.99-1.28]; P = .08) compared with placebo. All-cause 28-day mortality was 11.0% for abatacept vs 15.1% for placebo (odds ratio [OR], 0.62 [95% CI, 0.41-0.94]), 13.8% for cenicriviroc vs 11.9% for placebo (OR, 1.18 [95% CI 0.72-1.94]), and 10.1% for infliximab vs 14.5% for placebo (OR, 0.59 [95% CI, 0.39-0.90]). Safety outcomes were comparable between active treatment and placebo, including secondary infections, in all 3 substudies., Conclusions and Relevance: Time to recovery from COVID-19 pneumonia among hospitalized participants was not significantly different for abatacept, cenicriviroc, or infliximab vs placebo., Trial Registration: ClinicalTrials.gov Identifier: NCT04593940.
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- 2023
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29. The World's Longest Functioning Implant: A Verified Case Report.
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Linkow L, Iyer S, and Piermatti J
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- Humans, Esthetics, Dental, Mandible surgery, Dental Prosthesis, Implant-Supported, Denture, Overlay, Dental Implants
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Satisfactory function, esthetics, and phonetics together with long-term stability and minimal complications are all considered as metrics that define a successful outcome. The current case report is documentation of a mandibular subperiosteal implant with a successful follow-up of 56 years. Numerous issues can be credited for the long-term successful outcome including selection of the patient, heedfulness of basic anatomic and physiologic principles, design of the implant and superstructure, surgical execution, application of sound restorative principles, conscientious hygiene, and clockwork recare. The case demonstrates intense cooperation and coordination among the surgeon, restorative dentist, and laboratory technical staff, together with long-lasting patient compliance. Execution of the treatment with a mandibular subperiosteal implant helped this patient overcome the status of a dental cripple. The highlight of the case is that it is the longest success ever documented in the history of any type of implant treatment.
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- 2023
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30. Cerebrospinal fluid white cell count to red cell count ratio as a predictor of ventriculitis in patients with external ventricular drains.
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Brooks M, Duong D, Shivapathasundram G, and Sheridan M
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- Humans, Retrospective Studies, Cross-Sectional Studies, Drainage adverse effects, Leukocyte Count, Cerebral Ventriculitis diagnosis, Cerebral Ventriculitis etiology, Cerebral Ventriculitis cerebrospinal fluid
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Introduction: External ventricular drain (EVD) associated ventriculitis is a complication of EVD placement associated with significant morbidity and mortality. Gold-standard for EVD associated bacterial ventriculitis diagnosis involves cerebrospinal fluid (CSF) sampling from the EVD with microscopy, culture and sensitivity testing. The ratio of white blood cells to red blood cells has anecdotally been considered a predictive factor in diagnosing EVD associated ventriculitis, however no study has been done demonstrating this., Methods: A retrospective cross-sectional study was designed to assess whether the ratio of CSF white blood cells to red blood cells could be used to diagnose EVD associated ventriculitis. Data was collected for all patients undergoing EVD insertion at a major neurosurgical unit in Sydney, Australia. A receiver operator characteristics (ROC) curve was used to determine if this ratio was useful, and Youden's index was calculated to determine the appropriate cut-off point., Results: This sample of n = 157 consecutive patients a total of 29 patients were diagnosed with ventriculitis. The area under the ROC curve was significant (0.706, P <0.001), and Youden's index demonstrated an appropriate cut-off point was a ratio of 1:106., Discussion: CSF parameters have long been considered predictive of EVD associated ventriculitis. We demonstrated that using a component of routine testing it is possible to accurately predict a ventriculitis diagnosis. As the ratio is used, it enables discrimination in a raised white blood cell count due to local trauma with interventricular bleeding., Conclusion: CSF white blood cell to red blood cell ratio is an appropriate diagnostic test for ventriculitis., (© 2022 Royal Australasian College of Surgeons.)
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- 2022
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31. Left atrial myxoma with coronary artery disease.
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Javaid A, Khandait H, and Ong CK
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- Humans, Heart Atria diagnostic imaging, Coronary Angiography, Coronary Artery Disease complications, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease surgery, Myxoma complications, Myxoma diagnostic imaging, Myxoma surgery, Heart Neoplasms diagnostic imaging, Heart Neoplasms surgery
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Competing Interests: Competing interests: None declared.
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- 2022
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32. Troponemia Secondary to Air Duster Inhalant Abuse.
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Romero J, Abboud R, Elkattawy S, Romero A, Elkattawy O, Samak AAA, and Shamoon R
- Abstract
The abuse of inhalants has become a public health concern in the USA over the past decade. Compressed air duster cans currently available in the USA contain highly toxic substances including different hydrofluorocarbons (including tetrafluoroethane and difluoroethane) which exert a psychoactive effect on the central nervous system. Several cases of inhalant-induced lethal arrhythmia such as ventricular fibrillation evolving to torsade de pointes and leading to cardiac arrest, have been reported in the literature. Furthermore, multiorgan failure including liver and kidney injury has been described after inhalant abuse. We report the case of a 33-year-old man found diaphoretic and with a near syncopal episode after inhalation of several cans of Surf Onn electronic duster gas cleaner, who subsequently developed acute cardiac, liver and kidney injury., Learning Points: Although the pathophysiological mechanisms have not been fully elucidated, the hydrofluorocarbons in air duster cans may exert a psychoactive effect through GABA receptor stimulation and NMDA receptor inhibition.Clinicians should maintain a low threshold of suspicion for patients presenting with multiorgan failure, predominantly cardiac arrhythmias after inhalant overdose.Prompt recognition and early intervention are imperative for preventing fatal outcomes such as cardiac arrest secondary to life-threatening cardiac arrhythmias., Competing Interests: Conflicts of Interests: The authors declare there are no competing interests., (© EFIM 2022.)
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- 2022
- Full Text
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33. A Case of Hepatitis C Related Mixed Cryoglobulinemia Syndrome.
- Author
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Kayode-Ajala F, Ejikeme C, Picone J, and Sanyal A
- Abstract
Hepatitis C virus (HCV) is an RNA virus that preferentially infects hepatocytes and is transmitted through infected blood contact. Chronic hepatitis C can result in serious life-threatening conditions like fibrosis, cirrhosis, and liver cancer. Additionally, it can result in extrahepatic conditions including lymphoproliferative disease and mixed cryoglobulinemic vasculitis. Mixed cryoglobulinemic vasculitis occurs as a result of immune system dysfunction leading to immunoglobulin deposits into different blood vessels in the body. The main manifestations commonly seen are purpura, weakness, arthralgias. Other symptoms include peripheral neuropathy, arthritis, vasculitic skin ulcers, liver, and renal involvement. This case highlights a 57-year-old male with a medical history of substance use disorder, bilateral lower extremity ulcers, and chronic hepatitis C infection who presented with complaints of bilateral lower extremity wounds, abdominal distension, and scrotal swelling. Our patient was confirmed to have new-onset cirrhotic liver secondary to intravenous drug use, with worsening renal function. Further investigations confirmed the diagnosis of mixed cryoglobulinemia secondary to hepatitis C virus., Competing Interests: Declaration of conflicting interest The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2022 Greater Baltimore Medical Center.)
- Published
- 2022
- Full Text
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34. Acute Compartment Syndrome in the Setting of Weight Loss Supplements and Exercise-Induced Rhabdomyolysis.
- Author
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Rath P, Fichadiya H, Elkattawy S, Jesani S, Messalti M, Fichadiya H, and Sherer C
- Abstract
The growing prevalence of obesity in the USA has resulted in increased consumption of weight loss products that promote fat metabolism. Dietary supplements used for weight loss contain a wide variety of ingredients but the amount of scientific information available on these ingredients varies considerably. Such supplements have documented and undocumented adverse effects. Although the FDA frequently issues health advisories, the health consequences of consuming supplements are often overlooked by the general public. A common supplement used for weight loss is Hydroxycut. The ingredients used in the different forms of Hydroxycut products vary but generally include caffeine and green tea extract, which are responsible for a wide range of adverse effects. We present the case of 41-year-old man with a medical history of polysubstance abuse who developed acute compartment syndrome in the setting of rhabdomyolysis from prolonged immobilisation and the use of Hydroxycut. This case demonstrates the possible adverse effects of consuming weight loss herbal supplements like Hydroxycut. Healthcare professionals and consumers are encouraged to report serious adverse events or product quality problems with the use of these supplements to the FDA's MedWatch adverse event reporting program., Learning Points: The weight loss supplement Hydroxycut is sold in various formulations whose side effect profiles are not fully known; the latest formulation has a very high concentration of caffeine which increases the risk of rhabdomyolysis.Although uncommon, exercise-induced rhabdomyolysis can cause compartment syndrome, especially in the setting of concurrent use of weight loss supplements.High clinical suspicion, prompt diagnosis and early treatment are key to preventing complications from compartment syndrome., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2022.)
- Published
- 2022
- Full Text
- View/download PDF
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