BackgroundPrevious studies of radiological damage in rheumatoid arthritis (RA) have used candidate-gene approaches, or evaluated single genome-wide association studies (GWAS). We undertook the... Show moreBackgroundPrevious studies of radiological damage in rheumatoid arthritis (RA) have used candidate-gene approaches, or evaluated single genome-wide association studies (GWAS). We undertook the first meta-analysis of GWAS of RA radiological damage to: (1) identify novel genetic loci for this trait; and (2) test previously validated variants.MethodsSeven GWAS (2,775 RA cases, of a range of ancestries) were combined in a meta-analysis. Radiological damage was assessed using modified Larsen scores, Sharp van Der Heijde scores, and erosive status. Single nucleotide polymophsim (SNP) associations with radiological damage were tested at a single time-point using regression models. Primary analyses included age and disease duration as covariates. Secondary analyses also included rheumatoid factor (RF). Meta-analyses were undertaken in trans-ethnic and European-only cases.ResultsIn the trans-ethnic primary meta-analysis, one SNP (rs112112734) in close proximity to HLA-DRB1, and strong linkage disequilibrium with the shared-epitope, attained genome-wide significance (P = 4.2x10(-8)). In the secondary analysis (adjusting for RF) the association was less significant (P = 1.7x10(-6)). In both trans-ethnic primary and secondary meta-analyses 14 regions contained SNPs with associations reaching P<5x10(-6); in the European primary and secondary analyses 13 and 10 regions contained SNPs reaching P<5x10(-6), respectively. Of the previously validated SNPs for radiological progression, only rs660895 (tagging HLA-DRB1*04:01) attained significance (P = 1.6x10(-5)) and had a consistent direction of effect across GWAS.ConclusionsOur meta-analysis confirms the known association between the HLA-DRB1 shared epitope and RA radiological damage. The lack of replication of previously validated non-HLA markers highlights a requirement for further research to deliver clinically-useful prognostic genetic markers. Show less
Purpose Worldwide, more than 214 million people have left their country of origin. This unprecedented mass migration impacts health care in host countries. This article explores and synthesizes... Show morePurpose Worldwide, more than 214 million people have left their country of origin. This unprecedented mass migration impacts health care in host countries. This article explores and synthesizes literature on the healthcare experiences of migrants. Design A meta-ethnography study of qualitative studies was conducted. Methods Eight databases (Medline, the Cumulative Index to Nursing and Allied Health Literature [CINAHL], PsycINFO, Embase, Web of Science, Migration Observatory, National Health Service Scotland Knowledge Network, and Adaptive Spectrum and Signal Alignment [ASSIA]) were searched for relevant full-text articles in English, published between January 2006 and June 2016. Articles were screened against inclusion criteria for eligibility. Included articles were assessed for quality and analyzed using Noblit and Hare's seven-step meta-ethnography process. Findings Twenty-seven studies were included in the review. Five key contextualization dimensions were identified: personal factors, the healthcare system, accessing healthcare, the encounter, and the healthcare experience. These five areas all underlined the uniqueness of each individual migrant, emphasizing the need to treat a person rather than a population. Within a true person-centered approach, the individual's cultural background is fundamental to effective care. Conclusions From the findings, a model has been designed using the five dimensions and grounded in a person-centered care approach. This may help healthcare providers to identify weak points, as well as to improve the organization and healthcare professionals' ability to provide person-centered care to migrant patients. Clinical Relevance The proposed model facilitates identification of points of weakness in the care of migrant patients. Employing a person-centered care approach may contribute to improve health outcomes for migrant patients. Show less
Ghert, M.; Bhandari, M.; Deheshi, B.; Guyatt, G.; Holt, G.; O'Shea, T.; ... ; Vele 2015
