Publications by authors named "Katherine Henderson"

127 Publications

Examining the Bidirectional Association Between Body Esteem and Body Mass Index During Adolescence.

J Dev Behav Pediatr 2021 Apr 27. Epub 2021 Apr 27.

Carleton University Department of Psychology, Ottawa, ON, Canada; Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Anchor Psychological Services, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada.

Objective: Research on body esteem (weight and appearance esteem) and weight suggests that having a positive body esteem may be associated with more stable weight trajectories during adolescence, and adolescents with higher weight report lower levels of body esteem. However, bidirectional relationships between body esteem and weight have not yet been examined. This 3-year longitudinal study examined (1) bidirectional relationships between body esteem and body mass index (BMI) and (2) how BMI and body esteem changed together throughout adolescence.

Methods: Participants (N = 1163 adolescents, at time 1 [T1] baseline; 60.3% female) from a school-based community sample completed surveys approximately annually for 3 years.

Results: Latent growth modeling revealed that (a) among boys and girls, appearance and weight esteem scores decreased over time, (b) higher initial BMI scores were associated with slower decreases in appearance esteem over time. However, evidence for bidirectionality was not found, in which baseline appearance and weight esteem did not predict changes in BMI over time and vice versa.

Conclusion: Results suggest that changes in BMI and body esteem are co-occurring (rather than predictive) throughout adolescence. The decreasing trajectory of body esteem over time suggests the need for prevention efforts to improve body esteem throughout adolescence.
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http://dx.doi.org/10.1097/DBP.0000000000000945DOI Listing
April 2021

'It brings light to what you really put into your body': a focus group study of reactions to messages about nicotine reduction in cigarettes.

Tob Control 2021 Apr 16. Epub 2021 Apr 16.

School of Public Health, Georgia State University, Atlanta, Georgia, USA

Objective: In 2017, the US Food and Drug Administration (FDA) announced a proposed regulation to lower nicotine in cigarettes to minimally addictive levels to help smokers quit. We sought to explore effective message strategies communicating about nicotine reduction in cigarettes across the different key audiences that the regulation is most likely to influence.

Methods: We designed four types of messages: efficacy messages, risk messages, a message about alternative sources of nicotine and a compensation message. Sixteen virtual focus groups were conducted in Atlanta and San Francisco in April-May 2020. Data were analysed in NVivo 12.0 using a thematic analysis approach.

Findings: Exclusive smokers were receptive to both efficacy messages and risk messages. Dual users were the only group that was open to resorting to alternative sources of nicotine. Former smokers were critical of these messages as promoting the new kinds of cigarettes and potentially encouraging initiation and relapse of smoking. Non-smokers felt that efficacy messages downplayed the risks of smoking and did not scare people away from smoking. Presenting information that very low nicotine cigarettes (VLNCs) still contain harmful chemicals made smokers question continued smoking in the absence of nicotine and view VLNCs as harmful.

Conclusions: Messages communicating about nicotine reduction in cigarettes might help to motivate smokers to quit and can correct the misperceptions that VLNCs are less harmful. The FDA should consider specific target audiences and use different messages that complement each other in communicating about this regulation.
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http://dx.doi.org/10.1136/tobaccocontrol-2020-056312DOI Listing
April 2021

Increasing recruitment into covid-19 trials.

BMJ 2021 01 29;372:n235. Epub 2021 Jan 29.

Faculty of Intensive Care Medicine, London, UK.

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http://dx.doi.org/10.1136/bmj.n235DOI Listing
January 2021

What Motivates Smokers to Switch to ENDS? A Qualitative Study of Perceptions and Use.

Int J Environ Res Public Health 2020 11 28;17(23). Epub 2020 Nov 28.

School of Public Health, Georgia State University, Atlanta, GA 30303, USA.

Switching completely from cigarettes to electronic nicotine delivery systems (ENDS) may reduce health risks for addicted smokers. This paper provides information about perceptions and other factors that may influence smokers' ENDS use and substitution for cigarettes. We conducted 12 online focus groups ( = 61) among smokers who had never tried using ENDS (Never Users, = 11), currently used both cigarettes and ENDS (Dual Users, = 21), used but discontinued ENDS (Rejectors, = 14), and switched completely to ENDS use (Switchers, = 15). Thematic analysis was used to interpret the transcripts. Participants described initial interest in trying ENDS in hopes of quitting smoking and because of convenience (i.e., due to rules, regulations, or social norms). Risk perceptions and higher prices relative to cigarettes were reported as disadvantages of ENDS that discouraged initiation. Dual Users and Rejectors reported product problems (e.g., products breaking) and dissatisfaction (i.e., inability to satisfy cravings for cigarettes) as factors that lowered their substitutability for cigarettes or led to discontinuing ENDS use. Switchers indicated that satisfaction, lack of product problems, and perceived safety facilitated successfully switching from cigarette smoking to exclusive ENDS use. However, Switchers reported trying many products before they found ones that satisfied their needs. We recommend that policymakers consider the potential impact of tobacco control policies on smokers' motivation and ability to switch completely from cigarettes to ENDS.
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http://dx.doi.org/10.3390/ijerph17238865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729446PMC
November 2020

A Content Analysis of U.S. Adults' Open-Ended Responses to E-Cigarette Risk Messages.

Health Commun 2020 Oct 30:1-11. Epub 2020 Oct 30.

School of Public Health, Georgia State University.

To better understand the processing of e-cigarette prevention messages, we conducted a content analysis of 1,968 participants' open-ended responses to one of four messages, which focused on industry manipulation (), financial and psychological cost of vaping (), harmful chemicals in e-cigarettes (), or uncertainty about the ingredients of e-liquids (). Health Belief Model (HBM) and perceived message effectiveness (PME) constructs were coded and the frequency of each variable was compared across message conditions. Among the HBM constructs, perceived health threat had the most mentions overall (38.8%). Self-efficacy of staying away from vaping had the fewest mentions across all messages (0.56%). For PME, participants more frequently mentioned message perceptions (15.75% positive message perceptions, 8.38% negative) than effect perceptions (3.46% positive effect perceptions, 1.37% negative). received the highest number of mentions for positive message perceptions and received the highest number of mentions for positive effect perceptions. Future anti-vaping messages are recommended to address the efficacy element and to combine different themes to communicate harms of e-cigarettes.
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http://dx.doi.org/10.1080/10410236.2020.1837427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085203PMC
October 2020

ICOSL plasmacytoid dendritic cells as inducer of graft-versus-host disease, responsive to a dual ICOS/CD28 antagonist.

Sci Transl Med 2020 10;12(564)

Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

Acute graft-versus-host disease (aGVHD) remains a major complication of allogeneic hematopoietic cell transplantation (HCT). CD146 and CCR5 are proteins that mark activated T helper 17 (Th17) cells. The Th17 cell phenotype is promoted by the interaction of the receptor ICOS on T cells with ICOS ligand (ICOSL) on dendritic cells (DCs). We performed multiparametric flow cytometry in a cohort of 156 HCT recipients and conducted experiments with aGVHD murine models to understand the role of ICOSL DCs. We observed an increased frequency of ICOSL plasmacytoid DCs, correlating with CD146CCR5 T cell frequencies, in the 64 HCT recipients with gastrointestinal aGVHD. In murine models, donor bone marrow cells from ICOSL-deficient mice compared to those from wild-type mice reduced aGVHD-related mortality. Reduced aGVHD resulted from lower intestinal infiltration of pDCs and pathogenic Th17 cells. We transplanted activated human ICOSL pDCs along with human peripheral blood mononuclear cells into immunocompromised mice and observed infiltration of intestinal CD146CCR5 T cells. We found that prophylactic administration of a dual human ICOS/CD28 antagonist (ALPN-101) prevented aGVHD in this model better than did the clinically approved belatacept (CTLA-4-Fc), which binds CD80 (B7-1) and CD86 (B7-2) and interferes with the CD28 T cell costimulatory pathway. When started at onset of aGVHD signs, ALPN-101 treatment alleviated symptoms of ongoing aGVHD and improved survival while preserving antitumoral cytotoxicity. Our data identified ICOSL-pDCs as an aGVHD biomarker and suggest that coinhibition of the ICOSL/ICOS and B7/CD28 axes with one biologic drug may represent a therapeutic opportunity to prevent or treat aGVHD.
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http://dx.doi.org/10.1126/scitranslmed.aay4799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811191PMC
October 2020

COVID-19 and haemoglobin oxygen affinity: some clarity?

Br J Haematol 2020 09 17;190(5):723-724. Epub 2020 Aug 17.

Inflammation Biology, King's College London, London, UK.

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http://dx.doi.org/10.1111/bjh.17053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460983PMC
September 2020

COVID-19: resetting ED care.

Emerg Med J 2020 Aug 14;37(8):458-459. Epub 2020 Jul 14.

Emergency Department, Guys & St Thomas' NHS Foundation Trust, London, UK.

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http://dx.doi.org/10.1136/emermed-2020-210282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7418608PMC
August 2020

Haemoglobin oxygen affinity in patients with severe COVID-19 infection.

Br J Haematol 2020 08 28;190(3):e126-e127. Epub 2020 Jun 28.

School of Cardiovascular Medicine and Sciences, King's College London, London, UK.

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http://dx.doi.org/10.1111/bjh.16888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283631PMC
August 2020

Modifications to Electronic Nicotine Delivery Systems: Content Analysis of YouTube Videos.

J Med Internet Res 2020 06 2;22(6):e17104. Epub 2020 Jun 2.

School of Public Health, Georgia State University, Atlanta, GA, United States.

Background: As user modification can alter the addictiveness and toxicity of electronic nicotine delivery systems (ENDS), more research is needed to understand the types, motivations, risks, and information sources that lead to these product alterations. YouTube has been identified as a major platform where ENDS users obtain and share information about ENDS products and modifications. However, a comprehensive study of ENDS modification videos on YouTube is lacking.

Objective: This study aimed to analyze the content of YouTube videos depicting modifications of ENDS.

Methods: YouTube was searched in March 2019 to identify videos depicting ENDS modifications. Search terms were derived from interviews with ENDS users and current literature. We used 28 search phrases that combined the words vape and vaping with modification-related key terms (eg, custom build, modification, and dripping). The final sample included 168 videos.

Results: Videos were 1 to 108 min long (median 9.55). Presenters were largely male (117/168, 69.6%), white (94/168, 56.0%), and older than 25 years (94/168, 56.0%). Most videos gave how to instructions (148/168, 88.1%), but few offered warnings (30/168, 17.9%) or mentioned commercial alternatives to modifications they presented (16/168, 9.5%). The ENDS devices most often featured were drippers (63/168, 37.5%) and refillable tanks (37/168, 22.0%). The most often modified ENDS components were coils (82/168, 48.8%) and e-liquids (34/168, 20.2%), which included adding other substances, such as cannabis, to the e-liquids (6/168, 3.6%). Most videos portrayed ENDS modifications positively (106/168, 63.1% positive; 60/168, 35.7% neutral; and 2/168, 1.2% negative) and were either neutral or positive in their overall portrayal of ENDS devices (78/168, 46.4% positive; 89/168, 53.0% neutral; and 1/168, 0.6% negative).

Conclusions: This study identified several concerning trends in popular YouTube videos on ENDS modifications, including lack of warnings, the addition of marijuana derivatives to e-liquids, and the positive portrayal of ENDS devices and modifications. By identifying the types of modifications (coil and e-liquid being the most prevalent), this study sets an agenda for research on the effects of modifications.
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http://dx.doi.org/10.2196/17104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298628PMC
June 2020

Feasibility of Implementing a Family-Based Inpatient Program for Adolescents With Anorexia Nervosa: A Retrospective Cohort Study.

Front Psychiatry 2019 3;10:887. Epub 2019 Dec 3.

Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.

Manualized Family Based Therapy (FBT) is the treatment of choice for adolescent anorexia nervosa, but it is an outpatient treatment. Very little research has examined whether or how the principles of FBT might be successfully adapted to an inpatient setting, and there is little other evidence in the literature to guide us on how to best treat children and adolescents with eating disorders (EDs) while in hospital. This paper describes and provides treatment outcomes for an intensive inpatient program that was designed for the treatment of adolescents less than 18 years of age with severe anorexia nervosa, based on the principles of FBT. Each patient's family was provided with FBT adapted for an inpatient setting for the duration of the admission. Parents were encouraged to provide support for all meals in hospital and to plan meal passes out of hospital. A retrospective cohort study was conducted that examined the outcomes of 153 female patients admitted over a 5-year period. Outcome data focused primarily on weight change as well as psychological indicators of health (i.e., depression, anxiety, ED psychopathology). Paired t-tests with Bonferroni corrections showed significant weight gain associated with a large effect size. In addition, patients showed improvements in scores of mood, anxiety, and ED psychopathology (associated with small to medium effect sizes), though they continued to display high rates of body dissatisfaction and some ongoing suicidality at the time of discharge. This study shows that a specialized inpatient program for adolescents with severe EDs that was created using the principles of FBT results in positive short-term medical and psychological improvements as evidenced by improved weight gain and decreased markers of psychological distress.
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http://dx.doi.org/10.3389/fpsyt.2019.00887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901823PMC
December 2019

Educational Outcomes Resulting From Restructuring a Scholarship Course for Doctor of Pharmacy Students.

Am J Pharm Educ 2019 10;83(8):7246

Virginia Commonwealth University School of Pharmacy, Richmond, Virginia.

To compare educational outcomes between two iterations of a scholarship and research course for Doctor of Pharmacy (PharmD) students at Virginia Commonwealth University's School of Pharmacy. The first iteration of a course intended to teach pharmacy students the knowledge and skills necessary to design and conduct research involved lectures and application exercises, including limited guided questions about different aspects of the research process. In the fall of 2015, multiple structured activities and accompanying grading rubrics, each designed around the structure and content of a section of a research proposal, were introduced to the course to supplement lectures. Both iterations of the course culminated with students submitting a research proposal. After establishing interrater reliability, faculty members graded a random sample of 20 research proposals, 10 from each version of the course, and section-specific and overall proposal scores were compared. In the proposals submitted after the course revisions, significant improvements in three areas were identified: the overall score, the section-specific scores for research hypothesis/specific aims, and institutional review board (IRB) discussion/informed consent. Nominal, though not statistically significant, improvements were observed in other sections. Additional research is needed regarding the best instructional strategies to reinforce data analysis and statistical testing knowledge and skills in PharmD students. Overall, our findings support the hypothesis that a more formalized, guided approach for teaching research methods improves learning outcomes for PharmD students.
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http://dx.doi.org/10.5688/ajpe7246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6900817PMC
October 2019

'Weekend effect' and what senior doctors do.

Emerg Med J 2019 Dec 30;36(12):706-707. Epub 2019 Oct 30.

Royal College of Emergency Medicine, London EC4A 1DT, UK

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http://dx.doi.org/10.1136/emermed-2019-209179DOI Listing
December 2019

Development of the Ottawa Disordered Eating Screen for Youth: The ODES-Y.

J Pediatr 2019 12 11;215:209-215. Epub 2019 Oct 11.

Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Department of Psychology, Carleton University, Ottawa, Ontario, Canada.

Objective: To develop a concise screening tool that allows for early identification of disordered eating in youth.

Study Design: In this 2-step classification accuracy study, questions for the Ottawa Disordered Eating Screen-Youth, a 2-question screening tool (index test), were conceptualized by clinician-scientists from tertiary care pediatric eating disorder and weight-related clinics, and was validated using retrospective data (2004-2010) from a community-based study, the Research on Eating and Adolescent Lifestyles (REAL) study.

Results: Analyses of contrast between the index test and the reference standard using data from 2892 (1714 females) students between grade 7 and grade 12 revealed classification statistics of 67.1% for sensitivity, 85.9% for specificity, 4.7 for positive likelihood ratio, 0.38 for negative likelihood ratio, 50.6% for positive predictive value, and 92.4% for negative predictive value for females and 61.1% for sensitivity, 93.9% for specificity, and 9.9 for positive likelihood ratio, 0.41 for negative likelihood ratio, 32.3% for positive predictive value, and 98.0% for negative predictive value for males.

Conclusions: Our findings suggest that the index test has utility as a short and accurate screening tool for earlier detection of disordered eating thoughts and behaviors in youth. Additional research is needed to best determine how the index test can be administered to youth across various health care, school, public health, and surveillance settings in clinically sensitive pragmatic ways.
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http://dx.doi.org/10.1016/j.jpeds.2019.08.018DOI Listing
December 2019

The health and cost burden of antibiotic resistant and susceptible Escherichia coli bacteraemia in the English hospital setting: A national retrospective cohort study.

PLoS One 2019 10;14(9):e0221944. Epub 2019 Sep 10.

The Health Foundation, London, England.

Introduction: Antibiotic resistance poses a threat to public health and healthcare systems. Escherichia coli causes more bacteraemia episodes in England than any other bacterial species. This study aimed to estimate the burden of E. coli bacteraemia and associated antibiotic resistance in the secondary care setting.

Materials And Methods: This was a retrospective cohort study, with E. coli bacteraemia as the main exposure of interest. Adult hospital in-patients, admitted to acute NHS hospitals between July 2011 and June 2012 were included. English national surveillance and administrative datasets were utilised. Cox proportional hazard, subdistribution hazard and multistate models were constructed to estimate rate of discharge, rate of in-hospital death and excess length of stay, with a unit bed day cost applied to the latter to estimate cost burden from the healthcare system perspective.

Results: 14,042 E. coli bacteraemia and 8,919,284 non-infected inpatient observations were included. E. coli bacteraemia was associated with an increased rate of in-hospital death across all models, with an adjusted subdistribution hazard ratio of 5.88 (95% CI: 5.62-6.15). Resistance was not found to be associated with in-hospital mortality once adjusting for patient and hospital covariates. However, resistance was found to be associated with an increased excess length of stay. This was especially true for third generation cephalosporin (1.58 days excess length of stay, 95% CI: 0.84-2.31) and piperacillin/tazobactam resistance (1.23 days (95% CI: 0.50-1.95)). The annual cost of E. coli bacteraemia was estimated to be £14,346,400 (2012 £), with third-generation cephalosporin resistance associated with excess costs per infection of £420 (95% CI: 220-630).

Conclusions: E. coli bacteraemia places a statistically significant burden on patient health and the hospital sector in England. Resistance to front-line antibiotics increases length of stay; increasing the cost burden of such infections in the secondary care setting.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221944PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736296PMC
March 2020

Using hospital network-based surveillance for antimicrobial resistance as a more robust alternative to self-reporting.

PLoS One 2019 25;14(7):e0219994. Epub 2019 Jul 25.

The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom.

Hospital performance is often measured using self-reported statistics, such as the incidence of hospital-transmitted micro-organisms or those exhibiting antimicrobial resistance (AMR), encouraging hospitals with high levels to improve their performance. However, hospitals that increase screening efforts will appear to have a higher incidence and perform poorly, undermining comparison between hospitals and disincentivising testing, thus hampering infection control. We propose a surveillance system in which hospitals test patients previously discharged from other hospitals and report observed cases. Using English National Health Service (NHS) Hospital Episode Statistics data, we analysed patient movements across England and assessed the number of hospitals required to participate in such a reporting scheme to deliver robust estimates of incidence. With over 1.2 million admissions to English hospitals previously discharged from other hospitals annually, even when only a fraction of hospitals (41/155) participate (each screening at least 1000 of these admissions), the proposed surveillance system can estimate incidence across all hospitals. By reporting on other hospitals, the reporting of incidence is separated from the task of improving own performance. Therefore the incentives for increasing performance can be aligned to increase (rather than decrease) screening efforts, thus delivering both more comparable figures on the AMR problems across hospitals and improving infection control efforts.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219994PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657867PMC
March 2020

Using hospital network-based surveillance for antimicrobial resistance as a more robust alternative to self-reporting.

PLoS One 2019 25;14(7):e0219994. Epub 2019 Jul 25.

The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom.

Hospital performance is often measured using self-reported statistics, such as the incidence of hospital-transmitted micro-organisms or those exhibiting antimicrobial resistance (AMR), encouraging hospitals with high levels to improve their performance. However, hospitals that increase screening efforts will appear to have a higher incidence and perform poorly, undermining comparison between hospitals and disincentivising testing, thus hampering infection control. We propose a surveillance system in which hospitals test patients previously discharged from other hospitals and report observed cases. Using English National Health Service (NHS) Hospital Episode Statistics data, we analysed patient movements across England and assessed the number of hospitals required to participate in such a reporting scheme to deliver robust estimates of incidence. With over 1.2 million admissions to English hospitals previously discharged from other hospitals annually, even when only a fraction of hospitals (41/155) participate (each screening at least 1000 of these admissions), the proposed surveillance system can estimate incidence across all hospitals. By reporting on other hospitals, the reporting of incidence is separated from the task of improving own performance. Therefore the incentives for increasing performance can be aligned to increase (rather than decrease) screening efforts, thus delivering both more comparable figures on the AMR problems across hospitals and improving infection control efforts.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219994PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657867PMC
March 2020

Risk of invasive bacterial infections by week of age in infants: prospective national surveillance, England, 2010-2017.

Arch Dis Child 2019 09 30;104(9):874-878. Epub 2019 May 30.

Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.

Objective: To estimate the incidence of laboratory-confirmed, invasive bacterial infections (IBIs) by week of age in infants over a 7-year period.

Design: Analysis of prospective national surveillance data for England.

Setting: National Health Service hospitals in England.

Patients: Infants aged <1 year who were hospitalised with IBI.

Main Outcome Measures: IBI incidence by week of age, incidence rate ratio (IRR) at 8, 12 and 16 weeks compared with the first week of life, and the main pathogens responsible for IBI.

Results: There were 22 075 IBI episodes between 2010/2011 and 2016/2017. The lowest annual cases were in 2011/2012 (n=2 799; incidence, 412/100 000 population), increasing year-on-year to 3 698 cases in 2016/2017 (incidence, 552/100 000 population). The incidence was highest in the first week of life and then declined rapidly. In 2016/2017, compared with the first week of life, weekly IBI incidence was 92% lower at 8 weeks (IRR 0.08; 95% CI 0.06 to 0.10) and 96% lower at 16 weeks of age (IRR 0.04; 95% CI 0.03 to 0.06). In 2016/2017, was the most prevalent pathogen responsible for IBI (n=592, 16.0%), followed by group B (n=493, 13.3%), (n=400, 10.8%) and (n=304, 8.2%). The other pathogens were individually responsible for <5% of total cases. There were differences in age distribution of the pathogens with increasing age.

Conclusion: IBI incidence declines rapidly after the first week of life, such that infants have a very low risk of IBI by the time they are eligible for their routine immunisations from 8 weeks of age.
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http://dx.doi.org/10.1136/archdischild-2018-316191DOI Listing
September 2019

'The lesser devil you don't know': a qualitative study of smokers' responses to messages communicating comparative risk of electronic and combusted cigarettes.

Tob Control 2020 03 30;29(2):217-223. Epub 2019 Apr 30.

School of Public Health, Georgia State University, Atlanta, Georgia, USA

Introduction: Communicating to smokers that e-cigarettes deliver lower levels of harmful chemicals than combusted cigarettes is a challenging issue. This study qualitatively explored smokers' interpretations of messages communicating the risk of e-cigarettes relative to cigarettes (comparative risk messages).

Method: We developed 12 print comparative risk messages and evaluated them in 12 focus groups with 72 adult smokers (18+ years old) in Atlanta, Georgia.

Results: Participants interpreted uncertainty about health effects of e-cigarettes as an indicator of significant unknown risks, which some believed to be potentially more severe than the known effects of cigarettes (such as cancer and heart disease). Also, participants were sceptical about the lower risk claims. Some participants misinterpreted what 'switching completely' or 'switching 100% of the time' means, perceiving switching from e-cigarettes to combusted cigarettes as comparable with the use of both products. When chemicals in e-cigarettes were mentioned (eg, nicotine or formaldehyde), participants viewed e-cigarettes as very harmful and had difficulty reconciling this belief with the reduced risk claim. Comparative risk messages emphasising smoking risks were perceived as effective. Participants also appreciated being given an option to switch if they cannot quit. Participants suggested the inclusion of more facts and statistics and a credible message source (eg, public health agencies) to increase message effectiveness.

Conclusion: Comparative risk messages may be more acceptable to smokers if they show direct comparisons of the number of toxic chemicals in cigarettes and e-cigarettes, are attributed to a credible source(s), and emphasise smoking risks.
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http://dx.doi.org/10.1136/tobaccocontrol-2018-054883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821570PMC
March 2020

Effects of weight teasing and gender on body esteem in youth: A longitudinal analysis from the REAL study.

Body Image 2019 Jun 5;29:65-73. Epub 2019 Mar 5.

Carleton University Department of Psychology, Ottawa, ON, Canada; Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. Electronic address:

Weight teasing is associated with body dissatisfaction, but no study has examined the differential impact of the teasing source's gender. This study examined whether the longitudinal relationship between weight teasing (by peers), weight-related comments (by parents) and body esteem differed by the teasing sources' gender, and whether these relationships were moderated by victims' weight status and demographic factors. A school-based sample (N = 1197 at Time 1; 60% female) of adolescents completed surveys over approximately 2 years (Time 1-Time 3). Multilevel modeling showed that teasing from a male peer had a stronger, negative association with appearance esteem for female victims than males. Although weight teasing was more prevalent among youth with overweight/obesity, teasing from female peers had a stronger negative association with weight esteem for adolescents of average weight. Results suggest the weight teasing sources' gender may differentially impact the victims' body esteem, and highlights the need to consider these factors in weight teasing prevention strategies.
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http://dx.doi.org/10.1016/j.bodyim.2019.02.009DOI Listing
June 2019

Evaluation of the Effectiveness and Safety of Olanzapine as an Adjunctive Treatment for Anorexia Nervosa in Adolescents: An Open-Label Trial.

J Can Acad Child Adolesc Psychiatry 2018 Aug 1;27(3):197-208. Epub 2018 Jul 1.

Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario.

Objectives: To evaluate the effectiveness and safety of adjunctive olanzapine treatment for low weight adolescents with anorexia nervosa (AN).

Methods: A non-randomized open-label trial was conducted between 2010 and 2014. Participants received standard treatment and were invited to take olanzapine at study enrollment. Participants could accept, continue, or discontinue olanzapine as treatment progressed. Weight and psychological outcomes were monitored.

Results: Of 239 adolescents assessed, 65 met inclusion criteria, 38 enrolled in the study, and 32 were retained for analysis. Twenty-two participants took olanzapine () and ten participants did not (). Participants in the medication group demonstrated a higher rate of weight gain compared to those who did not receive olanzapine ( = .012). No serious adverse events were noted, although seven participants (31.8%) discontinued olanzapine due to a side effect.

Conclusion: Preliminary results suggest that olanzapine may help facilitate weight gain in adolescents with AN. The importance of medical monitoring over the course of treatment is discussed. .
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6054282PMC
August 2018

Association between use of different antibiotics and trimethoprim resistance: going beyond the obvious crude association.

J Antimicrob Chemother 2018 06;73(6):1700-1707

Modelling and Economics Unit, National Infection Service, Public Health England, London, UK.

Objectives: To evaluate the association between use of different antibiotics and trimethoprim resistance at the population level.

Methods: Monthly primary care prescribing data were obtained from NHS Digital. Positive Enterobacteriaceae records from urine samples from patients between April 2014 and January 2016 in England were extracted from PHE's Second Generation Surveillance System (SGSS). Elastic net regularization and generalized boosted regression models were used to evaluate associations between antibiotic prescribing and trimethoprim resistance, both measured at Clinical Commission Group level.

Results: In total, 2 487 635 (99%) of 2 513 285 urine Enterobacteriaceae samples from 1 667 839 patients were tested for trimethoprim resistance. Using both elastic net regularization and generalized boosted regression models, geographical variation in trimethoprim resistance among Enterobacteriaceae urinary samples could be partly explained by geographical variation in use of trimethoprim (relative risk = 1.14, 95% CI = 1.02-1.75; relative influence = 4.1) and penicillins with extended spectrum (mainly amoxicillin/ampicillin in England) (relative risk = 1.19, 95% CI = 1.11-1.30; relative influence = 7.4). Nitrofurantoin use was associated with lower trimethoprim resistance levels (relative risk = 0.83, 95% CI =  0.57-0.96; relative influence = 9.2).

Conclusions: Use of amoxicillin/ampicillin explained more of the variance in trimethoprim resistance than trimethoprim use, suggesting that co-selection by these antibiotics is an important driver of trimethoprim resistance levels at the population level. Nitrofurantoin use was consistently associated with lower trimethoprim resistance levels, indicating that trimethoprim resistance levels could be lowered if trimethoprim use is replaced by nitrofurantoin.
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http://dx.doi.org/10.1093/jac/dky031DOI Listing
June 2018

Clinical Characteristics and Risk Factors for Poor Outcome in Infants Less Than 90 Days of Age With Bacterial Meningitis in the United Kingdom and Ireland.

Pediatr Infect Dis J 2018 09;37(9):837-843

From the Vaccine Institute & Institute for Infection and Immunity, St George's, University of London and St Georges University Hospitals NHS Trust, London, United Kingdom.

Background: To describe the clinical characteristics and risk factors associated with poor outcome in infants <90 days of age with bacterial meningitis.

Methods: Prospective, enhanced, national population-based active surveillance for infants <90 days of age with bacterial meningitis in the United Kingdom and Ireland between July 2010 and July 2011. Infants were identified through the British Paediatric Surveillance Unit, laboratory surveillance and meningitis charities.

Results: Clinical details was available for 263 of 298 (88%) infants where a bacterium was identified, 184 (70%) were born at term. Fever was reported in 143 (54%), seizures in 73 (28%), bulging fontanelle in 58 (22%), coma in 15 (6%) and neck stiffness in 7 (3%). Twenty-three (9%) died and 56/240 (23%) of the survivors had serious central nervous system complications at discharge. Temperature instability [odds ratio (OR), 2.99; 95% confidence interval (CI): 1.21-7.41], seizures (OR, 7.06; 95% CI: 2.80-17.81), cerebrospinal fluid protein greater than the median concentration (2275 mg/dL; OR, 2.62; 95% CI: 1.13-6.10) and pneumococcal meningitis (OR, 4.83; 95% CI: 1.33-17.58) were independently associated with serious central nervous system complications while prematurity (OR, 5.84; 95% CI: 2.02-16.85), low birthweight (OR, 8.48; 95% CI: 2.60-27.69), coma at presentation (OR, 31.85; 95% CI: 8.46-119.81) and pneumococcal meningitis (OR, 4.62; 95% CI: 1.19-17.91) were independently associated with death.

Conclusions: The classic features of meningitis were uncommon. The presentation in young infants is often nonspecific, and only half of cases presented with fever. A number of clinical and laboratory factors were associated with poor outcomes; further research is required to determine how knowledge of these risk factors might improve clinical management and outcomes.
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http://dx.doi.org/10.1097/INF.0000000000001917DOI Listing
September 2018

A single centre prospective cohort study addressing the effect of a rule-in/rule-out troponin algorithm on routine clinical practice.

Eur Heart J Acute Cardiovasc Care 2019 Aug 4;8(5):404-411. Epub 2017 Dec 4.

1 King's College London BHF Centre, St Thomas' Hospital, London, UK.

Aims: In 2015, the European Society of Cardiology introduced new guidelines for the diagnosis of acute coronary syndromes in patients presenting without persistent ST-segment elevation. These guidelines included the use of high-sensitivity troponin assays for 'rule-in' and 'rule-out' of acute myocardial injury at presentation (using a '0 hour' blood test). Whilst these algorithms have been extensively validated in prospective diagnostic studies, the outcome of their implementation in routine clinical practice has not been described. The present study describes the change in the patient journey resulting from implementation of such an algorithm in a busy innercity Emergency Department.

Methods And Results: Data were prospectively collected from electronic records at a large Central London hospital over seven months spanning the periods before, during and after the introduction of a new high-sensitivity troponin rapid diagnostic algorithm modelled on the European Society of Cardiology guideline. Over 213 days, 4644 patients had high-sensitivity troponin T measured in the Emergency Department. Of these patients, 40.4% could be 'ruled-out' based on the high-sensitivity troponin T concentration at presentation, whilst 7.6% could be 'ruled-in'. Adoption of the algorithm into clinical practice was associated with a 37.5% increase of repeat high-sensitivity troponin T measurements within 1.5 h for those patients classified as 'intermediate risk' on presentation.

Conclusions: Introduction of a 0 hour 'rule-in' and 'rule-out' algorithm in routine clinical practice enables rapid triage of 48% of patients, and is associated with more rapid repeat testing in intermediate risk patients.
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http://dx.doi.org/10.1177/2048872617746850DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691597PMC
August 2019

Resurgence of scarlet fever in England, 2014-16: a population-based surveillance study.

Lancet Infect Dis 2018 02 27;18(2):180-187. Epub 2017 Nov 27.

National Infection Service, Public Health England, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare-Associated Infection & Antimicrobial Resistance, Imperial College, London, UK.

Background: After decades of decreasing scarlet fever incidence, a dramatic increase was seen in England beginning in 2014. Investigations were launched to assess clinical and epidemiological patterns and identify potential causes.

Methods: In this population-based surveillance study, we analysed statutory scarlet fever notifications held by Public Health England from 1911 to 2016 in England and Wales to identify periods of sudden escalation of scarlet fever. Characteristics of cases and outbreaks in England including frequency of complications and hospital admissions were assessed and compared with the pre-upsurge period. Isolates from throat swabs were obtained and were emm typed.

Findings: Data were retrieved for our analysis between Jan 1, 1911, and Dec 31, 2016. Population rates of scarlet fever increased by a factor of three between 2013 and 2014 from 8·2 to 27·2 per 100 000 (rate ratio [RR] 3·34, 95% CI 3·23-3·45; p<0·0001); further increases were observed in 2015 (30·6 per 100 000) and in 2016 (33·2 per 100 000), which reached the highest number of cases (19 206) and rate of scarlet fever notifcation since 1967. The median age of cases in 2014 was 4 years (IQR 3-7) with an incidence of 186 per 100 000 children under age 10 years. All parts of England saw an increase in incidence, with 620 outbreaks reported in 2016. Hospital admissions for scarlet fever increased by 97% between 2013 and 2016; one in 40 cases were admitted for management of the condition or potential complications. Analysis of strains (n=303) identified a diversity of emm types with emm3 (43%), emm12 (15%), emm1 (11%), and emm4 (9%) being the most common. Longitudinal analysis identified 4-yearly periodicity in population incidence of scarlet fever but of consistently lower magnitude than the current escalation.

Interpretation: England is experiencing an unprecedented rise in scarlet fever with the highest incidence for nearly 50 years. Reasons for this escalation are unclear and identifying these remains a public health priority.

Funding: None.
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http://dx.doi.org/10.1016/S1473-3099(17)30693-XDOI Listing
February 2018

Measuring distance through dense weighted networks: The case of hospital-associated pathogens.

PLoS Comput Biol 2017 Aug 3;13(8):e1005622. Epub 2017 Aug 3.

The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, United Kingdom.

Hospital networks, formed by patients visiting multiple hospitals, affect the spread of hospital-associated infections, resulting in differences in risks for hospitals depending on their network position. These networks are increasingly used to inform strategies to prevent and control the spread of hospital-associated pathogens. However, many studies only consider patients that are received directly from the initial hospital, without considering the effect of indirect trajectories through the network. We determine the optimal way to measure the distance between hospitals within the network, by reconstructing the English hospital network based on shared patients in 2014-2015, and simulating the spread of a hospital-associated pathogen between hospitals, taking into consideration that each intermediate hospital conveys a delay in the further spread of the pathogen. While the risk of transferring a hospital-associated pathogen between directly neighbouring hospitals is a direct reflection of the number of shared patients, the distance between two hospitals far-away in the network is determined largely by the number of intermediate hospitals in the network. Because the network is dense, most long distance transmission chains in fact involve only few intermediate steps, spreading along the many weak links. The dense connectivity of hospital networks, together with a strong regional structure, causes hospital-associated pathogens to spread from the initial outbreak in a two-step process: first, the directly surrounding hospitals are affected through the strong connections, second all other hospitals receive introductions through the multitude of weaker links. Although the strong connections matter for local spread, weak links in the network can offer ideal routes for hospital-associated pathogens to travel further faster. This hold important implications for infection prevention and control efforts: if a local outbreak is not controlled in time, colonised patients will appear in other regions, irrespective of the distance to the initial outbreak, making import screening ever more difficult.
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http://dx.doi.org/10.1371/journal.pcbi.1005622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542422PMC
August 2017

Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience.

Ann Emerg Med 2017 Nov 26;70(5):659-671. Epub 2017 Jun 26.

Kings College London, UK.

Study Objective: Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying "normal" processes. The study objective is to examine escalation policies in theory and practice.

Methods: This was a mixed-method study involving a conceptual analysis of National Health Service escalation policies (n=12) and associated escalation actions (n=92), as well as a detailed ethnographic study of escalation in situ during a 16-month period in a large UK ED (n=30 observations).

Results: The conceptual analysis of National Health Service escalation policies found that their use requires the ability to dynamically reconfigure resources (staff and equipment), change work flow, and relocate patients. In practice, it was discovered that when the ED is under pressure, these prerequisites cannot always be attained. Instead, escalation processes were adapted to manage pressures informally. This adaptive need ("work as done") was found to be incompletely specified in policies ("work as imagined").

Conclusion: Formal escalation actions and their implementation in practice differed and varied in their effectiveness. Monitoring how escalation works in practice is essential in understanding whether and how escalation policies help to manage workload.
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http://dx.doi.org/10.1016/j.annemergmed.2017.04.032DOI Listing
November 2017