Browsing by Author "Clarke, Ann E"

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    Hydroxychloroquine prescription trends and predictors for excess dosing per recent ophthalmology guidelines
    (2018-07-05) Jorge, April M; Melles, Ronald B; Zhang, Yuqing; Lu, Na; Rai, Sharan K; Young, Lucy H; Costenbader, Karen H; Ramsey-Goldman, Rosalind; Lim, S. Sam; Esdaile, John M; Clarke, Ann E; Urowitz, M. B; Askanase, Anca; Aranow, Cynthia; Petri, Michelle; Choi, Hyon
    Abstract Background Hydroxychloroquine (HCQ) retinopathy may be more common than previously recognized; recent ophthalmology guidelines have revised recommendations from ideal body weight (IBW)-based dosing to actual body weight (ABW)-based dosing. However, contemporary HCQ prescribing trends in the UK remain unknown. Methods We examined a UK general population database to investigate HCQ dosing between 2007 and 2016. We studied trends of excess HCQ dosing per ophthalmology guidelines (defined by exceeding 6.5 mg/kg of IBW and 5.0 mg/kg of ABW) and determined their independent predictors using multivariable logistic regression analyses. Results Among 20,933 new HCQ users (78% female), the proportions of initial HCQ excess dosing declined from 40% to 36% using IBW and 38% to 30% using ABW, between 2007 and 2016. Among these, 47% of women were excess-dosed (multivariable OR 12.52; 95% CI 10.99–14.26) using IBW and 38% (multivariable OR 1.98; 95% CI,1.81–2.15) using ABW. Applying IBW, 37% of normal and 44% of obese patients were excess-dosed; however, applying ABW, 53% of normal and 10% of obese patients were excess-dosed (multivariable ORs = 1.61 and 0.1 (reference = normal); both p < 0.01). Long-term HCQ users showed similar excess dosing. Conclusion A substantial proportion of HCQ users in the UK, particularly women, may have excess HCQ dosing per the previous or recent weight-based guidelines despite a modest decline in recent years. Over half of normal-BMI individuals were excess-dosed per the latest guidelines. This implies the potential need to reduce dosing for many patients but also calls for further research to establish unifying evidence-based safe and effective dosing strategies.
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    “If we are waiting for the numbers alone, we will miss the point”: a qualitative study of the perceived rise of food allergy and associated risk factors in the Greater Accra Region, Ghana
    (2017-07-11) Atiim, George A; Elliott, Susan J; Clarke, Ann E
    Abstract Background Globally, food allergy [FA] is considered a growing health epidemic. While much of what is known comes from developed countries, there is growing interest in the epidemiology of FA in developing regions such as sub-Saharan Africa. Indeed, researchers are beginning to document the incidence and prevalence of FA and sensitization. The results outlined in this paper stem from an exploratory qualitative study examining the emergence of the health risk of FA in Ghana, a country undergoing epidemiologic changes. Methods Between June and August, 2015, we conducted thirty-seven (37) semi-structured in-depth interviews. This comprised seventeen (17) healthcare workers across 12 public and private hospitals and twenty (20) individuals with FA and families with allergic children. All interviews were recorded and transcribed verbatim. Transcripts were analyzed to develop thematic areas that characterize perceptions and experiences around FA. Results Three key broad themes arise from this study. First, FA is an emerging health risk, whose incidence is perceived to be increasing. Second, participants expressed mixed perceptions about the public health burden of FA. Third, participants identified individual and societal factors that may be influencing FA risks and susceptibility. Conclusion Our research suggests FA is a growing but unrecognized public health concern. There is the need for health policies and researchers to consider the full extent of ongoing epidemiologic changes for the health of populations in developing regions.
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    Nitrated nucleosome levels and neuropsychiatric events in systemic lupus erythematosus; a multi-center retrospective case-control study
    (2017-12-22) Ferreira, Isabel; Croca, Sara; Raimondo, Maria G; Matharu, Manjit; Miller, Sarah; Giles, Ian; Isenberg, David; Ioannou, Yiannis; Hanly, John G; Urowitz, Murray B; Anderson, Nicole; Aranow, Cynthia; Askanase, Anca; Bae, Sang-Cheol; Bernatsky, Sasha; Bruce, Ian N; Buyon, Jill; Clarke, Ann E; Dooley, Mary A; Fortin, Paul; Ginzler, Ellen; Gladman, Dafna; Gordon, Caroline; Inanc, Murat; Jacobsen, Søren; Kalunian, Kenneth; Kamen, Diane; Khamashta, Munther; Lim, Sam; Manzi, Susan; Merrill, Joan; Nived, Ola; Peschken, Christine; Petri, Michelle; Ramsey-Goldman, Rosalind; Ruiz-Irastorza, Guillermo; Sanchez-Guerrero, Jorge; Steinson, Kristjan; Sturfelt, Gunnar K; van Vollenhoven, Ronald; Wallace, Daniel J; Zoma, Asad; Rahman, Anisur
    Abstract Background In patients with systemic lupus erythematosus (SLE) there is no serological test that will reliably distinguish neuropsychiatric (NP) events due to active SLE from those due to other causes. Previously we showed that serum levels of nitrated nucleosomes (NN) were elevated in a small number of patients with NPSLE. Here we measured serum NN in samples from a larger population of patients with SLE and NP events to see whether elevated serum NN could be a marker for NPSLE. Methods We obtained serum samples from patients in the Systemic Lupus International Collaborative Clinics (SLICC) inception cohort. This included 216 patients with NP events and two matched controls with SLE but no NP events for each of these patients. For the NP patients we tested samples taken before, during and after the NP event. Results Twenty-six patients had events attributed to SLE according to the most stringent SLICC attribution rule. In these patients there was no association between onset of event and elevated serum NN. In 190 patients in whom events were not attributed to SLE by the SLICC rules, median serum NN was elevated at the onset of event (P = 0.006). The predominant clinical features in this group of 190 patients were headache, mood disorders and anxiety. Conclusions Serum NN levels rise at the time of an NP event in a proportion of patients with SLE. Further studies are needed to determine the value of serum NN as a biomarker for NPSLE.