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    Sep 2012
    Senior Lecturer
    University College Cork · Department of Epidemiology and Public Health
    Cork, Ireland
    Aug 2011 - Aug 2012
    Senior Researcher
    Trinity College Dublin · Department of Pharmacology and Therapeutics
    Dublin, Ireland
    Aug 2006 - Aug 2008
    PostDoc Position
    Harvard University · Harvard School of Public Health
    Boston, United States
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    A systems thinking to tackle NCD Burden in Ireland
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    Background: Long-term survival after lung transplantation (LTx) is hampered by Bronchiolitis Obliterans Syndrome (BOS), morphologically presented by OB. Since the pathogenesis is still not fully understood and the prognosis remains poor a good animal model is indispensable. Aim: The development of a new model of BOS after LTx. Methods: C57Bl6 mice underwent LTx with BALB/C donor lungs and were sacrificed at 2, 4, 6, 10 and 12 weeks after LTx. Staining with H&E and Sirius Red (not shown) were performed. Results: Histology showed two types of lesions. Type I lesions are characterized by lymphocytic bronch(iol)itis and functional lung parenchyma. These lesions seem to resolve over time. Type II lesions are demonstrated by fibrotic plugs growing into the airway lumen, resembling true BO lesions in humans. The surrounding parenchyma however is not functional. ![Figure][1] Conclusions: Allograft LTx in mice mimics human histology of BO, optimalisation of this model will open new perspectives to study pathogenesis of chronic rejection after LTx. [1]: pending:yes
    This study utilises an ecological design to analyse the relation between concurrent temporal trends in sudden infant death syndrome (SIDS) rates and prevalence of smoke-free households with infants in the USA, controlling for an important risk factor, infant supine sleep position. Annual state-specific SIDS cases were computed using period linked birth/infant death files; the prevalence of 100% smoke-free homes with infants using Tobacco Use Supplement to the Current Population Survey data, and percentage of infants in supine sleep position from National Infant Sleep Position data, for years 1995-2006. Incidence rate ratios relating trends in SIDS cases and risk factors were determined using time-series negative binomial regression. Population-level health effects were assessed with secondhand smoke (SHS) exposure population attributable fractions and excess attributable SIDS deaths. For every 1% absolute increase in the prevalence of smoke-free homes with infants, SIDS rates decreased 0.4% from 1995 to 2006, controlling for supine sleep position. Nationally, it is possible that 20% of the 1326 total SIDS cases were attributable to childhood SHS exposure at home in 2006 with potentially 534 fewer infant deaths attributable to SHS exposure in 2006 than in 1995, owing to an increasing prevalence of 100% smoke-free homes with infants. Cumulatively, 4402 (lower 95% CI) to 6406 (upper 95% CI) excess SIDS cases may have been attributable to SHS exposure in the home over the 12-year study period. The uptake of voluntary restrictions on smoking inside the home may present a public health benefit for infants in their first year of life. In light of inherent ecological study design limitations, these results warrant further individual level research linking postnatal SHS exposure and SIDS.
    Childhood asthma is a recurring health burden and symptoms of severe asthma in children are also emerging as a health and economic issue. This study examined changing patterns in symptoms of severe asthma and allergies (ever eczema and hay fever), using the Irish International Study of Asthma and Allergies in Childhood (ISAAC) protocol. ISAAC is a cross-sectional self-administered questionnaire survey of randomly selected representative post-primary schools. Children aged 13-14 years were studied: 2,670 (in 1995), 2,273 (in 1998), 2,892 (in 2002-2003), and 2,805 (in 2007). Generalized linear modelling using Poisson distribution was employed to compute adjusted prevalence ratios (PR). A 39% significant increase in symptoms of severe asthma was estimated in 2007 relative to the baseline year 1995 (adjusted PR: 1.39 [95% CI: 1.14-1.69]) increasing from 12% in 1995 to 15.3% in 2007. Opposite trends were observed for allergies, showing a decline in 2007, with an initial rise. The potential explanations for such a complex disease pattern whose aetiological hypothesis is still evolving are speculative. Changing environmental factors may be a factor, for instance, an improvement in both outdoor and indoor air quality further reinforcing the hygiene hypothesis but obesity as a disease modifier must also be considered.
    Temporal trends in paediatric encounters for otitis media (OM) were last characterised and observed to be steadily increasing from 1975 to the mid-1990 s. The present study uses an ecological design to quantify trends in paediatric encounters for OM concurrent with a period of decline of an important risk factor, secondhand smoke (SHS) exposure among children. Annual paediatric ambulatory visit and hospital discharge rates for children ≤ 6 years with OM as primary diagnosis were computed with nationally representative data for 1993-2006. Percentages of households with children ≤ 6 years and no-smoking rules were computed using Tobacco Use Supplement to the Current Population Survey data. Average annual percentage changes were determined for covariate-adjusted rates of paediatric encounters for OM using joinpoint analysis. While percentages of homes with children and no-smoking rules increased by 89% from 45.5% in 1993 to 86.1% in 2006, average annual covariate-adjusted paediatric encounters for OM decreased by 4.6% (95% CI 4.5% to 4.8%) for ambulatory visits and by 9.8% (95% CI 9.1% to 10.6%) for hospital discharges. Coverage by 7-valent pneumococcal conjugate vaccination (PCV7) increased since 2002, while little variation occurred in other potentially associated risk factors. Paediatric encounter rates for OM decreased steadily over a 13-year period reversing a previously reported long-term increasing trend reported. Reduced SHS exposure, PCV7 coverage since 2002 and other factors may have contributed to the decline. Further research is needed to provide direct estimates of paediatric encounter rates in exposed and unexposed populations for causal inference.
    Cardiovascular risk factors in children are increasing at an alarming rate in the western world. However, there is limited information regarding these in the South Asian children. This review attempts at summarizing such evidence. South Asians are remarkable for the earlier onset of adult cardiovascular disease (CVD) by almost a decade compared to the Caucasians. We identified published literature, mainly on PubMed, Embase and Cochrane library using specific search terms such as lipid abnormalities, high blood pressure, hyperglycemia, tobacco use, obesity, physical inactivity, and unhealthy dietary practices. Atherosclerotic CVD processes begin early in childhood and are influenced over the life course by genetic and potentially modifiable risk factors and environmental exposure. 80% of adult CVD burden will fall on the developing nations by 2020. The concept of primordial prevention is fast emerging as a necessary prevention tool to curb adult CVD epidemic. Established guidelines and proven preventive strategies on cardiovascular health exist; however, are always implemented half-heartedly. Composite screening and prediction tools for adults can be adapted and validated in children tailored to South Asian population. South Asian children could be at a greater risk of developing cardiovascular risk factors at an earlier stage, thus, timely interventions are imperative.
    Evidence is emerging that obesity-associated cardiovascular disorders (CVD) show variations across regions and ethnicities. However, it is unclear if there are distinctive patterns of abdominal obesity contributing to an increased CVD risk in South Asians. Also, potential underlying mechanistic pathways of such unique patterns are not comprehensively reported in South Asians. This review sets out to examine both. A comprehensive database search strategy was undertaken, namely, PubMed, Embase and Cochrane Library, applying specific search terms for potentially relevant published literature in English language. Grey literature, including scientific meeting abstracts, expert consultations, text books and government/non-government publications were also retrieved. South Asians have 3-5% higher body fat than whites, at any given body mass index. Additional distinctive features, such as South Asian phenotype, low adipokine production, lower lean body mass, ethno-specific socio-cultural and economic factors, were considered as potential contributors to an early age-onset of obesity-linked CVD risk in South Asians. Proven cost-effective anti-obesity strategies, including the development of ethno-specific clinical risk assessment tools, should be adopted early in the life-course to prevent premature CVD deaths and morbidity in South Asians.
    The association between parent-reported postnatal secondhand tobacco smoke exposure in the home and neurobehavioral disorders (attention-deficit/hyperactivity disorder, learning disabilities, and conduct disorders) among children younger than 12 years in the United States was examined using the 2007 National Survey on Children's Health. Excess neurobehavioral disorders attributable to secondhand smoke (SHS) exposure in the home in 2007 were further investigated. The methods used in this study were multivariable logistic regression models that accounted for potential confounders and complex survey designs to evaluate associations. A total of 6% of 55 358 children (aged < 12 years), corresponding to a weighted total of 4.8 million children across the United States, were exposed to SHS in the home. The weighted prevalence and 95% confidence intervals of each of the children's neurobehavioral outcomes were 8.2% (7.5-8.8) with learning disabilities, 5.9% (5.5-6.4) with attention-deficit/hyperactivity disorder, and 3.6% (3.1-4.0) with behavioral and conduct disorders. Children exposed to SHS at home had a 50% increased odds of having ≥2 childhood neurobehavioral disorders compared with children who were not exposed to SHS. Boys had a significantly higher risk. Older children, especially those aged 9 to 11 years, and those living in households with the highest poverty levels were at greater risk. In absolute terms, 274 100 excess cases in total of these 3 disorders could have been prevented if children had not been exposed to SHS in their homes. The findings of the study, which are associational and not necessarily causal, underscore the health burden of childhood neurobehavioral disorders that may be attributable to SHS exposure in homes in the United States.
    Aim: This study examined the prevalence of coronary risk factors and significant predictors of coronary artery disease (CAD) in one of the poorest states of Eastern India among a unique ethnic urban population that is experiencing changing lifestyle patterns. Methods: A multi-stage probability sampling from a sampling frame of 37 electoral wards geographically representative of the urban population of Berhampur, with a population of 307,724 in 2001, was based on an estimated sample of 1200 with adequate power. One thousand one hundred and seventy eight subjects (590 males; 588 females) ≥20 years of age were finally selected. In addition to socio-demographic characteristics, physiological, behavioral, anthropometric and biochemical parameters were ascertained using interviewer-completed questionnaires and appropriate clinical examinations. Both descriptive and multivariable logistic regression analyses were performed. Results: The overall prevalence of CAD was 10%. The main coronary risk factor prevalence rates were: hypertension (37%); smoking (27%); hypercholesterolemia (23%); diabetes (16%); central obesity (49%); physical inactivity levels (34%); and 47% had low HDL levels. Overall, age, central obesity, hypertension (adjusted odds ratio: 2.2; 95% confidence interval: 1.4; 3.4), physical inactivity levels and diabetes in females alone were significant predictors of CAD. Conclusions: A high CAD prevalence of 10%, with higher rates of some classical cardiovascular risk factors such as diabetes, hypertension and physical inactivity levels, reinforce the need for a comprehensive CAD prevention and control program. This is the first study conducted in one of the poorest states within the fold of an emerging economy, clearly suggesting the ubiquitous nature of the CAD epidemic. © 2010 World Heart Federation. Published by Elsevier Ltd. All rights reserved.
    Background: Ireland introduced a comprehensive workplace smoke-free legislation in March, 2004. Smoking-related adverse birth outcomes have both health care and societal cost implications. The main aim of this study was to determine the impact of the Irish smoke-free legislation on small-for-gestationa-age (SGA) births.
    Background Cardiovascular disorders (CVD) are due to a constellation of modifiable and non-modifiable risk factors – some known and others unknown. Such risk factors are reported to vary across ethnicities. CVD will likely become a major public health and clinical problem in Asia such that by the year 2020 Asia will have more individuals with CVD than any other region. However, the current evidence on variations in cardiovascular risk factors both from a clinical and an epidemiological perspective with special reference to developing country settings is limited. In this context, we set out to review the existing evidence and to summarize the findings.Methods We did not carry out a systematic review but pursued a similar structure. We abstracted the most appropriate published literature from electronic databases, namely, PubMed, Embase and the Cochrane Library applying specific search terms. We searched grey literature and followed up bibliographic references.ResultsEthnicity is emerging as an independent risk factor contributing to the rising epidemic of CVD in developing countries. Furthermore, increasing rates of urbanization have led to striking changes in lifestyle patterns resulting in decreasing physical activity, increasing weight and, consequently, increasing rates of diabetes, hypertension and dyslipidemia in urban Asians.Conclusions Variations in selected cardiovascular risk factors in developing countries were identified. Prediction tools and risk assessments need to be population-specific and sensitive to ethnic minorities. This summary of evidence could help to shift priorities to populations for targeted cardiovascular prevention and control measures where resources are limited.
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