• Application of neurite orientation dispersion and density imaging (NODDI) to a tau pathology model of Alzheimer's disease.

      Colgan, N; Siow, B; O'Callaghan, J M; Harrison, I F; Wells, J A; Holmes, H E; Ismail, O; Richardson, S; Alexander, D C; Collins, E C; et al. (NeuroImage, 2015-10-23)
      Increased hyperphosphorylated tau and the formation of intracellular neurofibrillary tangles are associated with the loss of neurons and cognitive decline in Alzheimer's disease, and related neurodegenerative conditions. We applied two diffusion models, diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI), to in vivo diffusion magnetic resonance images (dMRI) of a mouse model of human tauopathy (rTg4510) at 8.5months of age. In grey matter regions with the highest degree of tau burden, microstructural indices provided by both NODDI and DTI discriminated the rTg4510 (TG) animals from wild type (WT) controls; however only the neurite density index (NDI) (the volume fraction that comprises axons or dendrites) from the NODDI model correlated with the histological measurements of the levels of hyperphosphorylated tau protein. Reductions in diffusion directionality were observed when implementing both models in the white matter region of the corpus callosum, with lower fractional anisotropy (DTI) and higher orientation dispersion (NODDI) observed in the TG animals. In comparison to DTI, histological measures of tau pathology were more closely correlated with NODDI parameters in this region. This in vivo dMRI study demonstrates that NODDI identifies potential tissue sources contributing to DTI indices and NODDI may provide greater specificity to pathology in Alzheimer's disease.
    • Are Family Doctors Compliant with Breast Family History Guidelines?

      Thomas, Joe; Sugrue, Michael; Curran, Sharon; Furey, Michelle; Sugrue, Ryan (Advances in Breast Cancer Research, 2013-10)
    • An assessment of burn care professionals' attitudes to major burn.

      Murphy, A D; Healy, C; Purcell, E; Fitzgerald, E; Kelly, J L; Department of Plastic, Reconstructive & Hand Surgery, University College Hospital, Galway, Ireland. Adrian.murphy@mac.com (2008-06)
      The resuscitation of severe burn remains a controversial area within the burn care profession. There is ongoing debate as to what percentage burn is associated with a sufficient quality of life to support initial resuscitation efforts. We conducted a survey of delegates at the 39th Annual Meeting of the British Burns Association (2005), regarding attitudes towards resuscitation following major burns. Respondents were asked the maximum percentage total body surface area (TBSA) burn beyond which they would not wish to be resuscitated. They were also asked what maximum TBSA they perceived to be commensurate with an acceptable quality of life (QOL). One hundred and forty three of 300 delegates responded to the questionnaire. Thirty three percent of respondents would not wish to be resuscitated with 50-75% TBSA burns or greater. A further 35% would not wish to have life-sustaining intervention with 75-95% TBSA burns or greater. The remaining 32% indicated that they would not want resuscitation with TBSA burns>95%. Regardless of TBSA affected, 16% would not wish resuscitation if they had full thickness facial burns, a further 10% did not want resuscitation if both their hands and faces were affected. Our survey demonstrates the diversity of personal preference amongst burn care professionals. This would suggest that a unifying philosophy regarding the resuscitation of extensive burns will remain elusive.
    • Assessment of paediatric clinical audit.

      Perrem, L M; O'Neill, M B; Department of Paediatrics, Mayo General Hospital, Castlebar, Co Mayo. (Irish Medical Journal (IMJ), 2012-02)
      Consultant paediatricians in Ireland were surveyed to evaluate their perceptions of the hospital audit environment and assess their involvement in the audit process. Eighty nine (77%) replied of whom 66 (74%) had an audit department and 23 (26%) did not. Sixteen (18%) felt their hospital was well resourced for audit and 25 (28%) felt the culture was very positive but only 1 (1%) had protected time. For 61 (69%) consultants audit was very important with 38 (43%) being very actively involved in the process. The most frequent trigger for audit was non consultant hospital doctor (NCHD) career development, cited by 77 (87%). The new Professional Competence Scheme and the National Quality and Risk Management Standards will require the deficiencies identified in this survey be addressed.
    • Association between anxiety and depression symptoms with resistant hypertension and central hemodynamics: A pilot study.

      Mermerelis, A; Kyvelou, S-M; Vellinga, A; Papageorgiou, C; Stefanadis, C; Douzenis, A (Elsevier, 2016)
      The hypothesis that symptoms of anxiety and depression contribute to the development of hypertension has been controversial. Rutledge and Hogan found that the risk of developing hypertension is approximately 8% higher among people with psychological distress compared to those with minimal distress. People suffering from either severe depression or anxiety were two to three times more likely to develop hypertension. The aim of the present pilot study was to compare the prevalence of anxiety and depression in patients with resistant HTN (rHTN) who underwent renal denervation (RDN) versus medical management alone. An additional aim was to assess possible associations with central hemodynamics using the cardio-ankle vascular index (CAVI). The study included 34 patients who lacked a comorbid mental health disorder, had rHTN and were a mean age of 58.3 ± 11.2 years. Twenty-four hour ambulatory blood pressure monitoring (24 hABPM) was conducted in all patients, and they were divided into the following groups: group I (n = 20) underwent RDN and group II (n = 14) was treated with medical management alone. The mean office SBP and DBP measurements for group I were 163 mmHg and 92 mmHg, respectively; for group II, they were 159 mmHg and 91 mmHg, respectively. There was no significant difference in the duration of hypertension (10.1 vs 9.4 years, p = NS) or in the familial burden. Finally, there was no difference in the number of antihypertensive medications in the two groups (5.1 vs 5.5, p = NS). The evaluation of anxiety disorder was performed with the Hospital Anxiety Depression Scale (HADS)3,4. The Beck Depression Inventory (BDΙ) was used to evaluate depression5. Both scales consist of a simple, yet reliable, self-assessment screening questionnaire. For the HADS scale, a score of ≥11 is thought to indicate a significant case of psychological morbidity. The BDI is a 21-item self-report depression inventory that measures depressive symptoms. For each item, the score ranges from 1 to 4. The total score is obtained by summing the scores on each of the 21 questions. CAVI was measured with a Vasera VS-1500 (Fukuda Denshi, Tokyo, Japan) vascular screening device. Descriptive and univariate comparisons were made using SPSS (version 20.0). Due to the low number of subjects in each group, only non-parametric tests were used (Spearman for correlations, Mann-Whitney U-test for comparison of groups and Chi square for categorized comparisons). A p-value of 0.05 was set as the cut-off for significance. The HADS and BDI scores were highly correlated in the entire group [correlation coefficient (CC) = 0.787, p = 0.0001] as well as separately in each of the two groups [group I (CC) = 0.825, p = 0.0001 and group II (CC) = 0.779, p = 0.0001, respectively]. When comparing HADS and BDI scores between the two groups, no significant difference was identified. Comparing CAVI results, CAVIR, but not CAVIL, was significantly higher in group I (p = 0.02). In group II, there seems to be a negative correlation between the CAVIR, CAVIL and HADS scores [CAVIR-HADS CC = -0.597, p = 0.024; CAVIL-HADS CC = -0.668, p = 0.009] This small pilot study showed that there is a significant correlation between the two scores in the total population; however, patients treated with RDN are not different from those with medical management alone. A negative association was also noted between the anxiety scoring scale and CAVIR and CAVIL in patients treated with medical management alone. A previous study documented a lack of difference in the prevalence of panic, anxiety and depression between patients with rHTN and non-resistant controls. In agreement with our study, the prevalence of anxiety and depression was high in the two groups of patients with rHTN; however, the RDN made no difference in the total impact of the two modalities, which is in contrast with previous results. To the best of our knowledge, this report describes the first attempt to associate the arterial stiffness using the CAVI with anxiety and depression in this population. In a previous study, there was an association between an increased arterial stiffness, autonomic disbalance and depression in a young hypertensive population. The present study is a small pilot study that highlights the higher prevalence of depression and anxiety in patients with resistant hypertension, as well as a negative association with central hemodynamics. However, because the sample is small, acquisition of a larger sample size with the continuation of this study might reveal stronger correlations in the future.
    • Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria.

      O'Sullivan, E P; Avalos, G; O'Reilly, M; Dennedy, M C; Gaffney, G; Dunne, F; Department of Diabetes, Galway University Hospital, Galway, Ireland. (2012-01-31)
      AIMS/HYPOTHESIS: New diagnostic criteria for gestational diabetes mellitus (GDM) have recently been published. We wished to evaluate what impact these new criteria would have on GDM prevalence and outcomes in a predominantly European population. METHODS: The Atlantic Diabetes In Pregnancy (DIP) programme performed screening for GDM in 5,500 women with an oral glucose tolerance test at 24-28 weeks. GDM was defined according to the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and compared with previous WHO criteria; maternal and neonatal adverse outcomes were prospectively recorded. RESULTS: Of the participants, 12.4% and 9.4% were diagnosed with GDM using IADPSG and WHO criteria, respectively. IADPSG GDM pregnancies were associated with a statistically significant increased incidence of adverse maternal outcomes (gestational hypertension, polyhydramnios and Caesarean section) and neonatal outcomes (prematurity, large for gestational age, neonatal unit admission, neonatal hypoglycaemia and respiratory distress). The odds ratio for the development of these adverse outcomes remained significant after adjustment for maternal age, body mass index and non-European ethnicity. Those women who were classified as having normal glucose tolerance by WHO criteria but as having GDM by IADPSG criteria also had significant adverse pregnancy outcomes. CONCLUSIONS/INTERPRETATION: GDM prevalence is higher when using newer IADPSG, compared with WHO, criteria, and these women and their offspring experience significant adverse pregnancy outcomes. Higher rates of GDM pose a challenge to healthcare systems, but improved screening provides an opportunity to attempt to reduce the associated morbidity for mother and child.
    • Atlantic Dip: a regional approach to the delivery of care results in improved pregnancy outcomes in women with pre-gestational diabetes mellitus.

      Avalos, G; Carmody, L; Dunne, F; Kirwin, B; Todd, M; Gallacher, Therese; Gaffney, G; Durkan, M; McHugh, C; 1. Department of Diabetes, Galway University Hospital, National University of Ireland, Galway, Ireland 2. Department of Obstetrics and Gynaecology, National University of Ireland, Galway, Ireland (2011)
      Background and aims: The Atlantic Diabetes in Pregnancy (DIP) group established in 2005 represents 5 antenatal centres in a wide geographical location. The group provides care for women with diabetes before during and after pregnancy. We examined the outcomes of pregnancy in 2 periods (2005-2007) and (2008-2010) before and after the implementation of a region wide approach to delivery of care. The process of care changed from stand alone clinics with different personnel to integrated pre-pregnancy (PPC) and combined diabetes antenatal clinics in a hub and spoke fashion supported by an electronic data collection system, clinical care guidelines, professional education and patient education materials. Materials and Methods: Maternal (Glycated Haemoglobin (HbA1C), attendance at PPC, uptake of folic acid, Caesarean Section (CS) rates) and fetal/neonatal (miscarriage, stillbirth and perinatal mortality, admission to neonatal unit and birth weight >4kg) outcomes were recorded. Results: 104 and 152 pregnancies (23% and 30% Type 2) occurred in periods 1 and 2 respectively. Attendance for PPC increased from 28% to 53%, uptake of folic acid from 43% to 57%, and % of women with glycated haemoglobin at booking <7% increased from 51% to 60% between the 2 periods. In addition HbA1C decreased across all trimesters for women with both type 1 and type 2 diabetes over time. Elective CS rate increased from 18% to 41% with no change in the emergency CS rate. The take home baby rate increased from 76% to 89% and miscarriage/deaths<24 weeks decreased from 22% to 11%. The stillbirth and perinatal mortality rates both decreased from 25 to 15/1000, admission to neonatal unit decreased from 63% to 57% and % of babies >4kg decreased from 32% to 24%. Conclusion: A regional approach to the delivery of care has resulted in better pregnancy preparation for the mother and better neonatal outcomes as a consequence, resulting in a higher take home baby rate. The higher elective CS rate needs to be addressed.
    • Atlantic DIP: Diabetes in Pregnancy: a comparative study of stress and wellbeing in women with established diabetes, gestational diabetes, and those without diabetes

      Lydon, K; McGuire, B; Owens, LA; Sarma, K; Avalos, G; Carmody, L; O'Connor, C; Nestor, L; Dunne, F; Department of Medicine, National University of Ireland, Galway, Galway, Ireland, 2School of Psychology, National University of Ireland, Galway, Galway, Ireland. (European Association for the Study of Diabetes, 2011-09-15)
      Background and aims: Diabetes in pregnancy increases the risk of maternal and perinatal morbidity and mortality. The experience of diabetes during pregnancy may be a significant source of stress, both because of the impact of the illness and associated treatments on the expectant mother and because of concern about the impact on the unborn child. In order to examine stress associated with diabetes during pregnancy, we carried out a prospective study in women with pre-existing (Type 1 or Type 2) Diabetes (PDM), Gestational Diabetes Mellitus (GDM), and non-diabetic pregnant controls (NDM). Materials and methods: The participants were 210 pregnant women - 25 with pre-existing diabetes (PDM), 77 with GDM and 108 healthy controls (NDM). All were attending antenatal services in six health care centres in Ireland. We measured stress and wellbeing with several standardised psychological questionnaires including The Pregnancy Experience Scale; The Depression Anxiety Stress Scale; the Multidimensional Perceived Social Support Scale; the Illness Perception Questionnaire-Diabetes; the Diabetes Self-Efficacy Scale; the SF-8 and the Problem Areas in Diabetes Scale. We hypothesized that diabetic women would report higher levels of stress than healthy controls and we also hypothesized that social support may confer a protective role. Results: We found a non-significant trend of increased stress and lower quality of life among diabetic women compared to non-diabetic controls. Women with PDM perceived their illness as having a higher impact on their lives than those with GDM (p<0.0001). However, women with pre-existing diabetes also reported significantly greater self-efficacy in relation to their diabetes management compared to their gestational diabetes counterparts (p<0.05). The results of the remaining questionnaires demonstrate a general trend towards higher distress in diabetic women compared to controls. The healthy controls reported higher perceived social support which may confer a protective role against psychological stress. Conclusion: These preliminary results suggest that pregnant diabetic women perceive themselves as having a lower quality of life and higher levels of stress in pregnancy, especially women with pre-existing diabetes. This may indicate a need for psychological support in these patients. However, further research is required.
    • ATLANTIC DIP: pregnancy outcome for women with pregestational diabetes along the Irish Atlantic seaboard.

      Dunne, Fidelma P; Avalos, Gloria; Durkan, Meave; Mitchell, Yvonne; Gallacher, Therese; Keenan, Marita; Hogan, Marie; Carmody, Louise A; Gaffney, Geraldine; Department of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland. fidelma.dunne@nuigalway.ie (2009-07)
      Prospective evaluation of pregnancy outcomes in pregestational diabetes along the Atlantic seaboard 2006-2007.
    • ATLANTIC DIP: simplifying the follow-up of women with previous gestational diabetes.

      Noctor, E; Crowe, C; Carmody, L A; Avalos, G M; Kirwan, B; Infanti, J J; O'Dea, A; Gillespie, P; Newell, J; McGuire, B; et al. (European journal of endocrinology / European Federation of Endocrine Societies, 2013-11)
      Previous gestational diabetes (GDM) is associated with a significant lifetime risk of type 2 diabetes. In this study, we assessed the performance of HbA1c and fasting plasma glucose (FPG) measurements against that of 75 g oral glucose tolerance testing (OGTT) for the follow-up screening of women with previous GDM.
    • Atlantic Dip: The impact of obesity on pregnancy outcome in Glucose tolerant women

      Owens, L; O'Sullivan, EP; Avalos, G (Diabetes Care, 2010)
    • ATLANTIC DIP: the impact of obesity on pregnancy outcome in glucose-tolerant women.

      Owens, Lisa A; O'Sullivan, Eoin P; Kirwan, Breeda; Avalos, Gloria; Gaffney, Geraldine; Dunne, Fidelma; Department of Medicine, National University of Ireland, Galway, Ireland. (2010-03)
      OBJECTIVE A prospective study of the impact of obesity on pregnancy outcome in glucose-tolerant women. RESEARCH DESIGN AND METHODS The Irish Atlantic Diabetes in Pregnancy network advocates universal screening for gestational diabetes. Women with normoglycemia and a recorded booking BMI were included. Maternal and infant outcomes correlated with booking BMI are reported. RESULTS A total of 2,329 women fulfilled the criteria. Caesarean deliveries increased in overweight (OW) (odds ratio 1.57 [95% CI 1.24-1.98]) and obese (OB) (2.65 [2.03-3.46]) women. Hypertensive disorders increased in OW (2.30 [1.55-3.40]) and OB (3.29 [2.14-5.05]) women. Reported miscarriages increased in OB (1.4 [1.11-1.77]) women. Mean birth weight was 3.46 kg in normal BMI (NBMI), 3.54 kg in OW, and 3.62 kg in OB (P < 0.01) mothers. Macrosomia occurred in 15.5, 21.4, and 27.8% of babies of NBMI, OW, and OB mothers, respectively (P < 0.01). Shoulder dystocia occur in 4% (>4 kg) compared with 0.2% (<4 kg) babies (P < 0.01). Congenital malformation risk increased for OB (2.47 [1.09-5.60]) women. CONCLUSIONS OW and OB glucose-tolerant women have greater adverse pregnancy outcomes.
    • ATLANTIC DIP: The prevalence of pre-diabetes/type 2 diabetes in an Irish population with gestational diabetes mellitus 1-5 years post index pregnancy

      Crowe, C; Noctor, E; Carmody, LA; Wickham, B; Avalos, G; Gaffney, G; O’Shea, P; Dunne, F (2012-08-15)
    • ATLANTIC-DIP: raised maternal body mass index (BMI) adversely affects maternal and foetal outcomes in glucose tolerant women classified using International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria

      Dennedy, MC; Avalos, G; O'Reilly, MW; O'Sullivan, EP; Dunne, F; Medicine, NUI, Galway, Galway, Ireland. (European Association for the Study of Diabetes, 2011-09-15)
      Background and aims: Raised maternal body mass index (BMI), in association with hyperglycaemia is associated with adverse pregnancy outcome. Whether BMI has an independent effect on adverse pregnancy outcome is not clear. We aimed to investigate the effects of raised maternal BMI on pregnancy outcome in glucose tolerant women, classified using the IADPSG criteria. Materials and methods: Prospective observational study of pregnancy outcome in a cohort of women attending an antenatal clinic recruited to a universal screening programme for gestational diabetes. Maternal outcomes included glucose, delivery mode, pregnancy induced hypertension (PIH), pre-eclampsia (PET), antepartum hemorrhage (APH) and postpartum hemorrhage (PPH). Fetal outcomes included birthweight, congenital malformation, fetal death, neonatal jaundice, hypoglycemia and respiratory distress. Analyses performed using stepwise logistic regression and decision trees. Analyses adjusted for maternal age, parity, cigarette smoking and ethnicity. Results: Increasing maternal BMI was associated with adverse pregnancy outcomes: higher cesarean section rates, pre-eclamptic toxemia, pregnancy induced hypertension, increased birth weight and congenital malformation. The association of normal range glucose with adverse pregnancy outcome was weak and did not interact with the effects of raised BMI. A BMI threshold of 28 kg/m2 was associated with a significant rise in adverse pregnancy outcome. Adverse obstetric outcome in association with raised BMI was greater in primiparous women. Conclusion: Raised maternal BMI, within the overweight range, is associated with adverse pregnancy outcomes. These adverse effects of BMI occur independently of maternal glucose.