Derek Alderson

Bio: Derek Alderson is an academic researcher from Royal College of Surgeons in Ireland. The author has contributed to research in topics: Preparedness & Cathelicidin. The author has an hindex of 2, co-authored 2 publications receiving 90 citations.

Rising to the challenge of multimorbidity

Abstract: Tuberculosis is a leading cause of infectious disease–related death worldwide; however, only 10% of people infected with Mycobacterium tuberculosis develop disease. Factors that contribute to protection could prove to be promising targets for M. tuberculosis therapies. Analysis of peripheral blood gene expression profiles of active tuberculosis patients has identified correlates of risk for disease or pathogenesis. We sought to identify potential human candidate markers of host defense by studying gene expression profiles of macrophages, cells that, upon infection by M. tuberculosis, can mount an antimicrobial response. Weighted gene coexpression network analysis revealed an association between the cytokine interleukin-32 (IL-32) and the vitamin D antimicrobial pathway in a network of interferon-γ– and IL-15–induced “defense response” genes. IL-32 induced the vitamin D–dependent antimicrobial peptides cathelicidin and DEFB4 and to generate antimicrobial activity in vitro, dependent on the presence of adequate 25-hydroxyvitamin D. In addition, the IL-15–induced defense response macrophage gene network was integrated with ranked pairwise comparisons of gene expression from five different clinical data sets of latent compared with active tuberculosis or healthy controls and a coexpression network derived from gene expression in patients with tuberculosis undergoing chemotherapy. Together, these analyses identified eight common genes, including IL-32, as molecular markers of latent tuberculosis and the IL-15–induced gene network. As maintaining M. tuberculosis in a latent state and preventing transition to active disease may represent a form of host resistance, these results identify IL-32 as one functional marker and potential correlate of protection against active tuberculosis.

Covid-19: Call for a rapid forward looking review of the UK's preparedness for a second wave-an open letter to the leaders of all UK political parties.

Abstract: Dear leaders of UK political parties, Several countries are now experiencing covid-19 flare-ups. While the future shape of the pandemic in the UK is hard to predict, the available evidence indicates that local flare-ups are increasingly likely and a second wave a real risk. Many elements of the infrastructure needed to contain the virus are beginning to be put in place, but substantial challenges remain. The job now is not only to deal urgently with the wide ranging impacts of the first phase of the pandemic, but to ensure that the country is adequately prepared to contain a second phase. You may have seen the recent editorial in The BMJ calling for a transparent rapid review of where we are and what needs to be done to prevent and prepare …

Bad air can also kill: residential indoor air quality and pollutant exposure risk during the COVID-19 crisis

Abstract: During the first outbreak of the SARS-CoV-2 pandemic the population, focusing primarily on the risk of infection, was generally inattentive to the quality of indoor air. Spain, and the city of Madrid in particular, were among the world's coronavirus hotspots. The country's entire population was subject to a 24/7 lockdown for 45 days. This paper describes a comparative longitudinal survey of air quality in four types of housing in the city of Madrid before and during lockdown. The paper analysed indoor temperatures and variations in CO2, 2.5 μm particulate matter (PM2.5) and total volatile organic compound (TVOC) concentrations before and during lockdown. The mean daily outdoor PM2.5 concentration declined from 11.04 µg/m3 before to 7.10 µg/m3 during lockdown. Before lockdown the NO2 concentration values scored as 'very good' 46% of the time, compared to 90.9% during that period. Although the city's outdoor air quality improved, during lockdown the population's exposure to indoor pollutants was generally more acute and prolonged. Due primarily to concern over domestic energy savings, the lack of suitable ventilation and more intensive use of cleaning products and disinfectants during the covid-19 crisis, indoor pollutant levels were typically higher than compatible with healthy environments. Mean daily PM2.5 concentration rose by approximately 12% and mean TVOC concentration by 37% to 559%. The paper also puts forward a series of recommendations to improve indoor domestic environments in future pandemics and spells out urgent action to be taken around indoor air quality (IAQ) in the event of total or partial quarantining to protect residents from respiratory ailments and concomitantly enhanced susceptibility to SARS-CoV-2, as identified by international medical research.

Examining variation in the measurement of multimorbidity in research: a systematic review of 566 studies.

Abstract: Funding: This work was supported by supported by Health Data Research UK (HDR-UK; grant number CFC0110) which receives its funding from the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and the Wellcome Trust. .

Beliefs about the body and pain: the critical role in musculoskeletal pain management.

Abstract: Background Beliefs about the body and pain play a powerful role in behavioural and emotional responses to musculoskeletal pain. What a person believes and how they respond to their musculoskeletal pain can influence how disabled they will be by pain. Importantly, beliefs are modifiable and are therefore considered an important target for the treatment of pain-related disability. Clinical guidelines recommend addressing unhelpful beliefs as the first line of treatment in all patients presenting with musculoskeletal pain. However, many clinicians hold unhelpful beliefs themselves; while others feel ill-equipped to explore and target the beliefs driving unhelpful responses to pain. As a result, clinicians may reinforce unhelpful beliefs, behaviours and resultant disability among the patients they treat. Methods To assist clinicians, in Part 1 of this paper we discuss what beliefs are; how they are formed; the impact they can have on a person's behaviour, emotional responses and outcomes of musculoskeletal pain. In Part 2, we discuss how we can address beliefs in clinical practice. A clinical case is used to illustrate the critical role that beliefs can have on a person's journey from pain and disability to recovery. Conclusions We encourage clinicians to exercise self-reflection to explore their own beliefs and better understand their biases, which may influence their management of patients with musculoskeletal pain. We suggest actions that may benefit their practice, and we propose key principles to guide a process of behavioural change.

Impact of multimorbidity on healthcare costs and utilisation: a systematic review of the UK literature

Abstract: Background Managing multimorbidity is complex for both patients and healthcare systems. Patients with multimorbidity often use a variety of primary and secondary care services. Country-specific research exploring the healthcare utilisation and cost consequences of multimorbidity may inform future interventions and payment schemes in the UK. Aim To assess the relationship between multimorbidity, healthcare costs, and healthcare utilisation; and to determine how this relationship varies by disease combinations and healthcare components. Design and setting A systematic review. Method This systematic review followed the bidirectional citation searching to completion method. MEDLINE and grey literature were searched for UK studies since 2004. An iterative review of references and citations was completed. Authors from all articles selected were contacted and asked to check for completeness of UK evidence. The National Institutes of Health National Heart, Lung, and Blood Institute quality assessment tool was used to assess risk of bias. Data were extracted, findings synthesised, and study heterogeneity assessed; meta-analysis was conducted when possible. Results Seventeen studies were identified: seven predicting healthcare costs and 10 healthcare utilisation. Multimorbidity was found to be associated with increased total costs, hospital costs, care transition costs, primary care use, dental care use, emergency department use, and hospitalisations. Several studies demonstrated the high cost of depression and of hospitalisation associated with multimorbidity. Conclusion In the UK, multimorbidity increases healthcare utilisation and costs of primary, secondary, and dental care. Future research is needed to examine whether integrated care schemes offer efficiencies in healthcare provision for multimorbidity.