Adults with cerebral palsy about twice as likely to develop cardiovascular and chronic respiratory diseases, RCSI study

Adults with cerebral palsy are about twice as likely to develop cardiovascular disease and chronic respiratory disease compared to adults without cerebral palsy, according to a new study led by RCSI (Royal College of Surgeons in Ireland) and Brunel University London.The study compared 1,700 adults with cerebral palsy and 5,000 adults without cerebral palsy to identify how many developed non-infectious diseases, such as asthma or stroke. The research is published in the current edition of NEUROLOGY. 

Patients with cerebral palsy were overall 75% more likely to have a non-communicable disease. After adjusting for other variables, the study found that adults with cerebral palsy were around twice as likely to develop cardiovascular disease and chronic respiratory disease, such as asthma, but not more likely to develop diabetes or cancer.

Adults with cerebral palsy were specifically 2.6 times more likely to develop heart failure, 5.5 times more likely to have a stroke, 2.2 times more likely to develop asthma, 1.6 times more likely to develop hypertension and 2.3 times more likely to develop ischaemic heart disease.

Globally, approximately 17 million people have cerebral palsy. Although cerebral palsy was historically considered a paediatric condition, the majority of children with cerebral palsy now survive into adulthood and many adults with cerebral palsy have a near normal life expectancy.

Cerebral palsy is not a progressive condition. However, at least a quarter of young adults report that their ability to walk gets worse, which may contribute to the development of chronic health conditions.

“Until recently, we did not know much about the consequences of ageing with cerebral palsy. Our findings highlight the need for further research into the management of non-communicable diseases in this population,” said Jennifer Ryan, the study’s lead author and StAR Research Lecturer at RCSI and Senior Lecturer at Brunel University London.

“Recent clinical guidelines for adults with cerebral palsy in the UK recommended that pathways need to be developed that allow adults with cerebral palsy access to a multidisciplinary team. However, adults with cerebral palsy in Ireland lack access to co-ordinated multidisciplinary support.”

Being able to access health professionals, such as physiotherapists, orthopaedic surgeons and neurologists with knowledge of cerebral palsy early, may slow deterioration in the patient’s function and prevent development of secondary conditions with age.

Dr Neil O'Connell, co-author, physiotherapist and senior lecturer at Brunel University London said:

"Our results clearly emphasise the importance of reframing how cerebral palsy is traditionally viewed; to recognise that it is not simply a condition of childhood. Health services should be designed and delivered with the aim of supporting people with cerebral palsy to be healthy and active throughout their lives."

The study was funded by the Brunel University London Research Catalyst Fund, and it involved collaborators from Brunel University London, University of Michigan-Medicine, London School of Hygiene and Tropical Medicine, Aberdeen Royal Infirmary, Hospital Clinico San Carlos, University of Surrey and Queen Mary University London.

Female medical students report higher rates of feeling intimidated in surgical attachments than male medical students

 A greater number of female medical students have experienced intimidation in their training than their male counterparts, according to a new research study published by researchers at RCSI (Royal College of Surgeons in Ireland).

15.8% of male medical students reported that they had never felt intimidated during their surgical attachments, compared to just 6.9% of female students. A third of male students never felt discouraged, but only a quarter of female students felt the same.

The researchers analysed 464 questionnaires completed by medical students in Dublin, Perdana and Penang. Almost 40% of respondents were male and 60% were female. The findings have been published in the latest online edition of the Postgraduate Medical Journal.

The research also suggests that a lack of role models in surgery is perceived as a drawback by 22.8% of female medical students, with only 9.4% of their male counterparts feeling the same.

The new study has found that male and female medical students were similar in terms of interest in a career in surgery – with 46.5% of males and 42.6% of females very or quite interested in a career in surgery. Yet, just 10 percent of surgeons in Ireland are female according to the 2017 Progress report by RCSI’s Working Group on Gender Diversity, led by Professor Deborah McNamara.

“Achieving gender parity is vital for the future of all medical specialties, especially surgery. Female medical students are a particularly important group to consider on the quest to achieve gender balance within the specialty. We have shown that a high percentage of students will have decided on their career path before they have graduated, often having been influenced by role models along the way,” said lead author Dr Ciara Cronin, RCSI Department of Surgery.

“Greater female participation in surgical careers may normalise work plans that include job sharing, parental leave and career breaks enabling a greater number of both male and female surgeons to successfully combine a surgical career with social and family responsibilities.”

The study also looked at the motivating factors for students when choosing a medical field for their career. Female students were significantly more influenced in their choice of surgical career by part-time work, parental leave, working hours and length of residency. Male students were significantly more influenced by salary than females towards a choice of surgical career. 

“According to our study, preference for a career in surgery declines with advancing years in medical school for both males and females. Medical students report high levels of feeling intimidated or ignored during their surgical placements, and enthusiasm for surgery reduces during medical school with exposure to this. These findings, along with the importance of role modelling, add further urgency to the need to address factors which make surgery less appealing to female medical graduates,” said Prof Peter Gillen, Associate Professor of Surgery at RCSI.

The intake to surgical training in Ireland remains high. There are currently 346 trainees across RCSI’s core and higher surgical training programmes; 216 are male and 130 are female.

Professor Deborah McNamara said, “The PROGRESS report identified an imperative that more is done to inform and encourage female medical students considering a career in surgery. This is an important research paper that will help RCSI to identify areas that need improvement. Over the last year, RCSI Dublin has established a student chapter affiliated with the Association of Women Surgeons to increase the access of RCSI medical students to female surgical mentors. This development was well received by students and it won best new student society for the 2018/19 academic year. Three specific surgical mentorship events have already taken place.”

RCSI research suggests that anti-rejection medications for multiple kidney transplants increase the risk of skin cancer

A study led by researchers at RCSI (Royal College of Surgeons in Ireland) has analysed the pattern of skin cancer rates in kidney transplant patients, which suggests the increased risk is related to the anti-rejection medications.

The research is published in: JAMA DERMATOLOGY  and was a collaboration between the National Cancer Registry Ireland and the National Kidney Transplant Service in Beaumont Hospital.

Patients who receive a kidney transplant are at increased risk of cancer, in particular skin cancer. The study found that this skin cancer risk falls when the transplant fails and the patients return to dialysis but rises again when they receive another transplant. However, the rate of skin cancer is still higher in patients with failed transplants than pre-transplant patients on dialysis.

Due to this pattern of skin cancer rates, the data suggests that the cancer risk is related to the stopping and starting of anti-rejection medications.

“In recipients of multiple kidney transplants, the incidence of nonmelanoma skin cancer fell during periods defined by transplant failure, but there was still an elevated risk. The incidence of cancer overall highlights the need for continued cancer surveillance during graft failure,” said the study’s lead author Dr Donal Sexton, Department of Nephrology and Kidney Transplantation, Beaumont Hospital, RCSI.

The study analysed the rates of cancer in 3,821 individual deceased and living kidney transplant recipients. Of the patients analysed, 3,215 recipients had one transplant, 522 recipients a second; and 84 recipients had three kidney transplants.

During the patient’s first kidney transplant, the rate of skin cancer rose 15 times higher than before the procedure. That skin cancer rate fell by half when the transplant failed and the patient returned to dialysis; however, the rate was still seven times higher than the pre-transplant patient’s rate. When they received a second transplant, the rate of skin cancer rose again to 12.8 times more than pre-transplant rate.

“Our study has provided a comprehensive analysis of cancer risk over multiple kidney transplants in the same individuals. However, the retrospective nature of the analysis makes it difficult to capture the effect of the lag between exposure, cancer development, presentation, and diagnosis, and which may vary by treatment period,“ said Professor Peter Conlon, Associate Professor of Medicine at RCSI.

RCSI is ranked among the top 250 (top 2%) of universities worldwide in the Times Higher Education World University Rankings (2019) and its research is ranked first in Ireland for citations. It is an international not-for-profit health sciences institution, with its headquarters in Dublin, focused on education and research to drive improvements in human health worldwide. RCSI has been awarded Athena Swan Bronze accreditation for positive gender practice in higher education.