The importance of advance care planning in parkinsonism is increasingly recognised. Existing evidence shows plans are infrequent in this population. Little is known about the details of the plans them Show more
The importance of advance care planning in parkinsonism is increasingly recognised. Existing evidence shows plans are infrequent in this population. Little is known about the details of the plans themselves and whether patient factors predict advance care planning practices. This study aimed to describe advance care planning in people with parkinsonism enrolled in the PRoactive Integrated Management and Empowerment (PRIME-UK) trial, and identify factors associated with advance care planning. This is a cross-sectional substudy of 211 participants within the PRIME-UK randomised controlled trial, a single-centre trial that randomised 214 people with parkinsonism to receive either a novel model of care (PRIME-Parkinson care) or usual care (ISRCTN trial ID 16783200). The presence of a treatment escalation plan was used as a measure of advance care planning. At the time of this study, a quarter (n=53, 25%) of participants had a treatment escalation plan. 45% of plans were created during an emergency hospital admission. 100 participants had appointed a lasting power of attorney (LPA). In adjusted regression models, increasing parkinsonism severity (OR 2.2, 95% CI 1.55 to 3.12), increasing frailty (OR 3.69, 95% CI 1.42 to 9.63) and increasing comorbidity (OR 2.51, 95% CI 1.53 to 4.14) were associated with having a treatment escalation plan. Treatment escalation plans for people with parkinsonism are frequently completed in advanced disease during emergency hospital admission. Many individuals are appointing LPAs, suggesting an interest in future planning that could be further supported by clinicians. Future research should explore interventions to improve proactive outpatient advance care planning. 16783200. Show less
A large number of genetic loci are associated with adult body mass index. However, the genetics of childhood body mass index are largely unknown. We performed a meta-analysis of genome-wide associatio Show more
A large number of genetic loci are associated with adult body mass index. However, the genetics of childhood body mass index are largely unknown. We performed a meta-analysis of genome-wide association studies of childhood body mass index, using sex- and age-adjusted standard deviation scores. We included 35 668 children from 20 studies in the discovery phase and 11 873 children from 13 studies in the replication phase. In total, 15 loci reached genome-wide significance (P-value < 5 × 10(-8)) in the joint discovery and replication analysis, of which 12 are previously identified loci in or close to ADCY3, GNPDA2, TMEM18, SEC16B, FAIM2, FTO, TFAP2B, TNNI3K, MC4R, GPR61, LMX1B and OLFM4 associated with adult body mass index or childhood obesity. We identified three novel loci: rs13253111 near ELP3, rs8092503 near RAB27B and rs13387838 near ADAM23. Per additional risk allele, body mass index increased 0.04 Standard Deviation Score (SDS) [Standard Error (SE) 0.007], 0.05 SDS (SE 0.008) and 0.14 SDS (SE 0.025), for rs13253111, rs8092503 and rs13387838, respectively. A genetic risk score combining all 15 SNPs showed that each additional average risk allele was associated with a 0.073 SDS (SE 0.011, P-value = 3.12 × 10(-10)) increase in childhood body mass index in a population of 1955 children. This risk score explained 2% of the variance in childhood body mass index. This study highlights the shared genetic background between childhood and adult body mass index and adds three novel loci. These loci likely represent age-related differences in strength of the associations with body mass index. Show less