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Papers by Tony Fitzgerald

Revista Española de Cardiología, 2007

Palabras clave: Predicción. Riesgo. Cardiovascular. Pre-vención. Factores de riesgo. ... Calibrac... more Palabras clave: Predicción. Riesgo. Cardiovascular. Pre-vención. Factores de riesgo. ... Calibración de la tabla SCORE de riesgo cardiovascular ... Susana Sansa, Anthony P. Fitzgeraldb, David Royoa, Ronan Conroyc y Ian Grahamd ... Estudio financiado por el Institut d'Estudis de la ...

Quality of Life Research, 2014

Purpose The health, well-being and quality of life of the world's 1.2 billion adolescents are glo... more Purpose The health, well-being and quality of life of the world's 1.2 billion adolescents are global priorities. A focus on their patterns or profiles of time-use and how these relate to health-related quality of life (HRQoL) may help to enhance their well-being and address the increasing burden of non-communicable diseases in adulthood. This study sought to establish whether distinct profiles of adolescent 24-h time-use exist and to examine the relationship of any identified profiles to self-reported HRQoL. Method This cross-sectional study gathered data from a random sample of 731 adolescents (response rate 52 %) from 28 schools (response rate 76 %) across Cork city and county. A person-centred approach, latent profile analysis, was used to examine adolescent 24-h time-use and relate the identified profiles to HRQoL. Results Three male profiles emerged, namely productive, high leisure and all-rounder. Two female profiles, higher study/lower leisure and moderate study/higher leisure, were identified. The quantitative and qualitative differences in male and female profiles support the gendered nature of adolescent time-use. No unifying trends emerged in the analysis of probable responses in the HRQoL domains across profiles. Females in the moderate study/ higher leisure group were twice as likely to have aboveaverage global HRQoL. Conclusion Distinct time-use profiles can be identified amongst adolescents, but their relationship with HRQoL is complex. Rich mixed-method research is required to illuminate our understanding of how quantities and qualities of time-use shape lifestyle patterns and how these can enhance the HRQoL of adolescents in the twenty-first century.

Statistics in Medicine, 2002

Individuals infected with the human immunodeÿciency virus type 1 (HIV-1) who initiate antiretrovi... more Individuals infected with the human immunodeÿciency virus type 1 (HIV-1) who initiate antiretroviral therapy typically experience a marked decline in concentrations of HIV-1 RNA in plasma. Often, however, viral rebound occurs within the ÿrst year of treatment and this rebound may be associated with resistance to antiretroviral therapy. For this reason, it is important to study the patterns of virological response of HIV-1 RNA to treatment. In particular, there is interest in the relationship between the lowest level of plasma HIV-1 RNA attained after initiation of therapy (nadir value) and the time until rebound. To investigate this question, we implement a simple and exible non-linear mixed e ects model for the trajectory of the HIV-1 RNA until rebound. This model is also consistent with biological insights into the e ects of treatment. We also show how the problem of censoring of HIV-1 RNA values at the lower limit of assay quantiÿcation can be addressed using a multiple imputation scheme. The algorithm is simple to implement and is based on accessible software. Our application makes use of data from clinical trial 315 conducted by the AIDS Clinical Trials Group (ACTG 315). We ÿnd a strong relationship between HIV-1 RNA nadir and time to rebound, with potentially important consequences for the management of HIV-infected individuals. Copyright ? 2002 John Wiley & Sons, Ltd.

Proceedings of the Nutrition Society, 2011

Journal of Epidemiology & Community Health, 2010

European Journal of Cardiovascular Prevention & Rehabilitation, 2009

Systematic COronary Risk Evaluation (SCORE), the risk estimation system recommended by the Europe... more Systematic COronary Risk Evaluation (SCORE), the risk estimation system recommended by the European guidelines on cardiovascular disease prevention, estimates 10-year risk of cardiovascular disease mortality based on age, sex, country of origin, systolic blood pressure, smoking status and either total cholesterol (TC) or TC/high-density lipoprotein cholesterol (HDL-C) ratio. As, counterintuitively, these two systems perform very similarly, we have investigated whether incorporating HDL-C and TC as separate variables improves risk estimation. The study consisted of 57,302 men and 47,659 women. Cox proportional hazards method was used to derive the function including HDL-C and an identical function without HDL-C for comparison. Risk charts were developed to illustrate the results. Inclusion of HDL-C resulted in a modest but statistically significant improvement in risk estimation, based on the area under receiver operating characteristic curve (AUROC); 0.814 versus 0.808, P value less than 0.0001, for the functions with and without HDL-C, respectively. Addition of HDL-C also resulted in a significant and important improvement in risk estimation as measured by net reclassification index, which is highly clinically relevant. Improvement in risk estimation was greatest in women from high-risk countries, in terms of both AUROC and net reclassification index. For the general population, the inclusion of HDL-C in risk estimation results in only a modest improvement in overall risk estimation based on AUROC. However, when using the more clinically that examines reclassification of individuals, clinically useful improvements occur. Inclusion of HDL may be particularly useful in women from high-risk countries and individuals with unusually high or low HDL-C levels. Addition of HDL-C is particularly applicable to electronic, interactive risk estimation systems such as HeartScore.

Epilepsia, 2009

Accurate diagnosis of neonatal seizures is critically important and is often made clinically, wit... more Accurate diagnosis of neonatal seizures is critically important and is often made clinically, without EEG (electroencephalography) monitoring. This observational study aimed to determine the accuracy and interobserver reliability of healthcare professionals in distinguishing clinically manifested seizures from other neonatal movements, when presented with clinical histories and digital video recordings only. Twenty digital video recordings of paroxysmal movements in term and preterm infants were selected from a video-EEG database. The movements were categorized as seizure and nonseizure using EEG. Health care professionals (n = 137) from eight neonatal intensive care units (NICUs) were shown the video recordings with additional relevant clinical data, excluding EEG findings. The observers were asked to indicate which movements they considered to be seizure or nonseizure. A multirater Kappa statistic was used to assess agreement between observers and with the true diagnosis. Twenty video clips (11 seizure, 9 nonseizure) were evaluated by 91 doctors and 46 other professionals. The average number of correctly identified events was 10/20. Clonic seizures were correctly identified most frequently (range 36.5-95.6% of observers). Subtle seizures were poorly identified (range 20.4-49.6% of observers). The interobserver agreement (Kappa) for doctors and other health care professionals was poor at 0.21 and 0.29, respectively. Agreement with the correct diagnosis was also poor at 0.09 for doctors and -0.02 for other healthcare professionals. It is often impossible to accurately differentiate between seizure-related and nonseizure movements in infants using clinical evaluation alone. In addition, doctors do not have a higher capacity for discriminating between neonatal paroxysmal events than other health care professionals. Until reliable continuous neurologic monitoring of newborn babies is available, it is likely that some babies with seizures will remain undetected and others with nonseizure movements will continue to be treated with potentially harmful anticonvulsants.

Diabetic Medicine, 1991

One-hundred and ninety-one men with Type 2 (non-insulin-dependent) diabetes mellitus, participant... more One-hundred and ninety-one men with Type 2 (non-insulin-dependent) diabetes mellitus, participants in the Whitehall Survey, were followed for 15 years. Age-adjusted all-cause and ischaemic heart disease (IHD) mortality rates were significantly increased in the diabetic men. Of four putative risk factors for IHD ascertained in the survey (plasma cholesterol, systolic blood pressure, cigarette smoking, body mass index) only blood pressure was a significant predictor in univariate Cox regression analysis. A review of comparable studies revealed lack of consistency in the association of these risk factors (derived from studies in non-diabetic populations) and mortality in individuals with Type 2 diabetes. Given the absence of clinical trial data, risk factor intervention in Type 2 diabetes is currently based upon inference derived from studies in non-diabetic subjects.

background The Dietary Approaches to Stop Hypertension (DASH) Trial provides critical data on the... more background The Dietary Approaches to Stop Hypertension (DASH) Trial provides critical data on the impact of a specific diet pattern (low in salt, fat, and processed foods and high in fruit and vegetables) on blood pressure (BP). The effect of compliance with a DASH-type diet on BP in a general population sample is less well defined. We studied associations between a DASH style diet and BP. methods We used cross-sectional data from a study of men and women aged 47-73 years (n = 2,047). Participants completed a physical examination that included 3 standardized clinical BP recordings. A subsample (n = 1,187) had ambulatory BP measurements (ABPM) taken. Diet was assessed using a DASH dietary score constructed from a standard Food Frequency Questionnaire. Lower scores indicated less healthy diets. Hypertension was defined as clinic BP ≥ 140/90 mm Hg on medication or as 24-hour ABPM ≥ 130/80 mmHg. results Inverse associations were evident between DASH and systolic BP (SBP). There was a difference in clinic SBP of 7.5 mm Hg and 5.1 mm Hg and a difference in ABPM SBP of 6.3 mm Hg and 5.4 mm Hg in men and women, respectively, between the highest and lowest DASH quintiles. In fully adjusted multivariable regression analysis, DASH score was inversely associated with SBP. Clear population differences in SBP were evident across DASH quintiles. conclusions The observed associations indicate that the findings are consistent with the hypothesis that adherence to DASH-equivalent diet can reduce BP at the population level. Public policy promoting a DASH-style healthy diet could have a significant impact on population health by reducing average BP in the population.

WHO has released prescriptive child growth standards for, among others, BMI-forage (BMI-FA), mid-... more WHO has released prescriptive child growth standards for, among others, BMI-forage (BMI-FA), mid-upper arm circumference-forage , and weight velocity. The ability of these indices to predict child mortality remains understudied, although growth velocity prognostic value underlies current growth monitoring programs. The study aims were first to assess, in children under 2, the independent and combined ability of these indices and of stunting to predict all-cause mortality within 3 mo, and second, the comparative abilities of weight-for-length (WFL) and BMI-FA to predict short-term (,3 mo) mortality. We used anthropometry and survival data from 2402 children aged between 0 and 24 mo in a rural area of the Democratic Republic of Congo with high malnutrition and mortality rates and limited nutritional rehabilitation. Analyses used Cox proportional hazard models and receiver operating characteristic curves. Univariate analysis and ageadjusted analysis showed predictive ability of all indices. Multivariate analysis without age adjustment showed that only very low weight velocity [HR = 3.82 (95%CI = 1.91, 7.63); P , 0.001] was independently predictive. With age adjustment, very low weight velocity [HR = 3.61 (95%CI = 1.80, 7.25); P , 0.001] was again solely retained as an independent predictor. There was no evidence for a difference in predictive ability between WFL and BMI-FA. This paper shows the value of attained BMI-FA, a marker of wasting status, and recent weight velocity, a marker of the wasting process, in predicting child death using the WHO child growth standards. WFL and BMI-FA appear equivalent as predictors. J. Nutr.

Objective: Poor-quality diet, regarded as an important contributor to health inequalities, is lin... more Objective: Poor-quality diet, regarded as an important contributor to health inequalities, is linked to adverse health outcomes. We investigated sociodemographic and lifestyle predictors of poor-quality diet in a population sample. Design: A cross-sectional analysis of the Survey of Lifestyle, Attitudes and Nutrition (SLÁ N). Diet was assessed using an FFQ (n 9223, response rate 5 89 %), from which a dietary score (the DASH (Dietary Approaches to Stop Hypertension) score) was constructed. Setting: General population of the Republic of Ireland. Subjects: The SLÁ N survey is a two-stage clustered sample of 10 364 individuals aged 18 years. Results: Adjusting for age and gender, a number of sociodemographic, lifestyle and health-related variables were associated with poor-quality diet: social class, education, marital status, social support, food poverty (FP), smoking status, alcohol consumption, underweight and self-perceived general health. These associations persisted when adjusted for age, gender and social class. They were not significantly altered in the multivariate analysis, although the association with social support was attenuated and that with FP was borderline significant (OR 5 1?2, 95 % CI 1?03, 1?45). A classical U-shaped relationship between alcohol consumption and dietary quality was observed. Dietary quality was associated with social class, educational attainment, FP and related core determinants of health. Conclusions: The extent to which social inequalities in health can be explained by socially determined differences in dietary intake is probably underestimated. The use of composite dietary quality scores such as the DASH score to address the issue of confounding by diet in the relationship between alcohol consumption and health merits further study. Keywords Dietary quality DASH score Dietary inequalities Diets are not consumed in isolation but are the product of a complex interplay between individuals' economic circumstances (1-3) , their social networks (4) and cultural beliefs (4,5) against the backdrop of both their individual (6,7) and global environments (8) and broader lifestyle behaviours (9-11). The impact of poor dietary habits on health outcomes is an important focus of contemporary health promotion strategies. It is recognised that the social determinants of dietary behaviour are multifaceted. Research that clarifies the determinants of dietary behaviour should help us target health promotion initiatives more effectively. Many indices have been developed over the past decades to assess dietary quality within specific populations on the basis of national dietary guidelines (12-14). Recently, the Dietary Approaches to Stop Hypertension (DASH) score was developed to assess adherence to the 'DASH eating plan', which has been successfully shown to substantially reduce blood pressure among hypertensive and normotensive adults (12) and reduce LDL cholesterol levels (15). Adherence to a DASH-style diet has also been associated with a lower risk of CHD and stroke, particularly among middle-aged women over a 24-year period (12) , highlighting the potential long-term benefits of the DASH diet in preventing CVD and other chronic diseases among healthy adults. Using a DASH score as an index of dietary quality, we examined the sociodemographic predictors of a poorquality diet with reference to social indicators (social support, food poverty (FP) and self-perceived area deprivation), lifestyle behaviours (smoking status and alcohol consumption) and health outcomes (BMI and pre-existing diabetes).

Suicide and Life-Threatening Behavior, 2007

The association between motives for deliberate self-harm (DSH), level of suicide intent, and hist... more The association between motives for deliberate self-harm (DSH), level of suicide intent, and history of DSH is poorly understood. As part of the WHO/ EURO Multicentre Study on Suicidal Behavior, the Suicide Intent Scale, and the Motives for Parasuicide Questionnaire were administered to 146 patients presenting with DSH in the Cork region in Ireland. DSH patients reporting high suicide intent were more motivated to escape from their problem (M = 3.15, p < .001) compared to those with low suicide intent, who were more motivated to appeal to others (M = 1.61, p < .001) and to get a temporary break from their problem (M = 2.47, p < .001). Repeaters more often reported motives aimed at escape (M = 2.98, p < .01), revenge (M = .60, p < .005), and appeal (M = 1.43, p = <.05). Selfharming patients are characterized by ambivalence and struggle with aversive thoughts and situations. Therapeutic approaches should include distress management and coping strategies. Deliberate self-harm (DSH) among young tionally (Corcoran, Keeley, O'Sullivan, & Perry, 2003; Schmidtke, Bille-Brahe, De men and women poses a significant challenge to the health system in Ireland and interna-Leo, & Kerkhof, 2005). An estimated 11,100 hospital presentations due to DSH were made by 8,600 individuals in Ireland in 2004 (National Parasuicide Registry, 2005

Public Health Nutrition, 2011

ObjectiveOwing to modern lifestyles, individuals are dependent on out-of-home eating. The caterin... more ObjectiveOwing to modern lifestyles, individuals are dependent on out-of-home eating. The catering sector can have a pivotal role in influencing our food choices. The objective of the present study was to examine the impact of a structured catering initiative on food choices in a public sector workplace setting.DesignA cross-sectional comparison study in two hospitals, one of which had implemented a catering initiative designed to provide nutritious food while reducing sugar, fat and salt intakes.SettingTwo public sector hospitals in Cork, Ireland.SubjectsA total of 100 random participants aged 18–64 years (fifty intervention, fifty non-intervention) who consumed at least one main meal in the hospital staff canteen daily. Each respondent was asked to complete one anonymous 24 h dietary recall and questionnaire. Food and nutrient analysis was conducted using WISP (Weighed Intake Software Program).ResultsReported mean intakes of total sugars (P < 0·001), total fat (P < 0·000), s...

European Journal of Cardiovascular Prevention & Rehabilitation, 2005

The relative importance of new risk factors for heart disease singly or in combination is uncerta... more The relative importance of new risk factors for heart disease singly or in combination is uncertain. We assessed relationships between C-reactive protein, homocysteine, cysteine, von Willebrand factor, activated factor XII and stable heart disease, as well as interaction with established risk factors. A case-control study of 260 cases of stable heart disease from the Irish component of the European Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE) II cohort and 260 age, sex-matched controls. C-reactive protein, homocysteine, cysteine, von Willebrand factor, activated factor XII and conventional risk factors were assayed or recorded. Interaction effects between new and conventional factors were assessed using additive and multiplicative models. C-reactive protein, homocysteine, cysteine and von Willebrand factor were significantly higher in cases than controls. Comparing the top fifth with the bottom four-fifths showed independent associations between heart disease and C-reactive protein [odds ratio (OR) 1.79; 95% confidence interval (CI) 1.12-2.86; P = 0.01], cysteine (OR 2.00; 95% CI 1.25-3.20; P = 0.004), von Willebrand factor (OR, 3.0; 95% CI 1.9-4.8; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). For homocysteine, the association was independent comparing the top tenth to the bottom nine-tenths (OR 1.95; 95% CI 1.02-3.41; P = 0.04). Activated factor XII was not associated with risk. The association between C-reactive protein and disease was U-shaped and a graded association existed between homocysteine, cysteine, von Willebrand factor and disease. C-reactive protein, homocysteine, cysteine and von Willebrand factor considerably increased risk associated with other factors, particularly smoking. Independent associations exist between stable heart disease and C-reactive protein, homocysteine, cysteine and von Willebrand factor. Strong combined effects were observed between these and conventional risk factors, particularly smoking. Smoking cessation may profoundly reduce risk associated with other risk factors. We found no evidence of a relationship between activated factor XII and disease.

Objective To describe and analyse the trend in age at menarche and menopause of women who have at... more Objective To describe and analyse the trend in age at menarche and menopause of women who have attended the breast cancerscreening program in the Valencian Community (VC) from 1992 to 2009 (born between 1927 and 1964). Materials and Methods Between 1992 and 2009, a retrospective cohort of participants in a population-based breast cancer-screening program in the VC was assessed. The study population was 695 313 women, 45e69 years. Trends in menarche and menopause aged by educational level (EL), nationality and territory by born cohorts were analysed. A regression analysis by the Joint-Point for the tendency was calculated. Results The age of menarche is earlier every cohort, 13.31 years (1927e1929) 12.59 years (1960e1964) (p<0.00001) by EL, mean 12 997 low EL vs 12 492 university EL (p<0001), being Spanish 12 722 vs 13 076 (p<0.0001) and living in urban area (12 717 vs 12 788) (p<0.0001). While these differences were very marked at the beginning of the period under study these being reduced in the last cohort. Joint point regression analysis shows significant differences in trend by varibles analysed. The age of natural menopause was 49.262 years in the 1927e1929 cohort, and 49.866 years in 1945e1949 (p<0.0001). Women with a low EL have an average age of menopause earlier than women of higher EL (49.531 vs 49.822) (p<0.001). Regression analysis of the trend shows that the delay was more pronounced for women with no education and primary studies (p<0.0001). Conclusions Menarche has advanced age and menopause is delayed, making broader reproductive cycles exist and different by the social variables studied.

Objective: Owing to modern lifestyles, individuals are dependent on out-of-home eating. The cater... more Objective: Owing to modern lifestyles, individuals are dependent on out-of-home eating. The catering sector can have a pivotal role in influencing our food choices. The objective of the present study was to examine the impact of a structured catering initiative on food choices in a public sector workplace setting. Design: A cross-sectional comparison study in two hospitals, one of which had implemented a catering initiative designed to provide nutritious food while reducing sugar, fat and salt intakes. Setting: Two public sector hospitals in Cork, Ireland. Subjects: A total of 100 random participants aged 18-64 years (fifty intervention, fifty non-intervention) who consumed at least one main meal in the hospital staff canteen daily. Each respondent was asked to complete one anonymous 24 h dietary recall and questionnaire. Food and nutrient analysis was conducted using WISP (Weighed Intake Software Program). Results: Reported mean intakes of total sugars (P , 0?001), total fat (P , 0?000), saturated fat (P , 0?000) and salt (P , 0?046) were significantly lower in the intervention hospital when adjusted for age and gender. In the intervention hospital, 72 % of respondents, compared with 42 % in the non-intervention hospital, complied with the recommended under-3 daily servings of food high in fat and sugar (P , 0?005). In the intervention hospital, 43 % of respondents exceeded the recommended salt intake of 4-6 g/d, compared with 57 % in the non-intervention hospital. Conclusions: Structured catering initiatives in the workplace are a potentially important option in the promotion of healthy food choices. Targeted public health programmes and health policy changes are needed to motivate caterers in the public sector and other industries to develop interventions that promote a healthy diet.