Getting the Grip on Nonspecific Treatment Effects: Emesis in Patients Randomized to Acupuncture or Sham Compared to Patients Receiving Standard Care

Background: It is not known whether or not delivering acupuncture triggers mechanisms cited as placebo and if acupuncture or sham reduces radiotherapy-induced emesis more than standard care. Methodology/Principal Findings: Cancer patients receiving radiotherapy over abdominal/pelvic regions were randomized to verum (penetrating) acupuncture (n = 109; 99 provided data) in the alleged antiemetic acupuncture point PC6 or sham acupuncture (n = 106; 101 provided data) performed with a telescopic non-penetrating needle at a sham point 2-3 times/week during the whole radiotherapy period. The acupuncture cohort was compared to a reference cohort receiving standard care (n = 62; 62 provided data). The occurrence of emesis in each group was compared after a mean dose of 27 Gray. Nausea and vomiting were experienced during the preceding week by 37 and 8% in the verum acupuncture group, 38 and 7% in the sham acupuncture group and 63 and 15% in the standard care group, respectively. The lower occurrence of nausea in the acupuncture cohort (verum and sham) compared to patients receiving standard care (37% versus 63%, relative risk (RR) 0.6, 95 % confidence interval (CI) 0.5-0.8) was also true after adjustment for potential confounding factors for nausea (RR 0.8, CI 0.6 to 0.9). Nausea intensity was lower in the acupuncture cohort (78% no nausea, 13% a little, 8% moderate, 1% much) compared to the standard care cohort (52% no nausea, 32% a little, 15% moderate, 2% much) (p = 0.002). The acupuncture cohort expected antiemetic effects from their treatment (95%). Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (RR 1.6; Cl 1.2-2.4). Conclusions/Significance: Patients treated with verum or sham acupuncture experienced less nausea and vomiting compared to patients receiving standard care, possibly through a general care effect or due to the high level of patient expectancy.Original Publication:Anna Enblom, Mats Lekander, Mats Hammar, Anna Johnsson, Erik Onelov, Martin Ingvar, Gunnar Steineck and Sussanne Börjeson, Getting the Grip on Nonspecific Treatment Effects: Emesis in Patients Randomized to Acupuncture or Sham Compared to Patients Receiving Standard Care, 2011, PLOS ONE, (6), 3, .http://dx.doi.org/10.1371/journal.pone.0014766Licensee: Public Library of Science (PLoS)http://www.plos.org

Managing uncertainty: a review of food system scenario analysis and modelling

Complex socio-ecological systems like the food system are unpredictable, especially to long-term horizons such as 2050. In order to manage this uncertainty, scenario analysis has been used in conjunction with food system models to explore plausible future outcomes. Food system scenarios use a diversity of scenario types and modelling approaches determined by the purpose of the exercise and by technical, methodological and epistemological constraints. Our case studies do not suggest Malthusian futures for a projected global population of 9 billion in 2050; but international trade will be a crucial determinant of outcomes; and the concept of sustainability across the dimensions of the food system has been inadequately explored so far. The impact of scenario analysis at a global scale could be strengthened with participatory processes involving key actors at other geographical scales. Food system models are valuable in managing existing knowledge on system behaviour and ensuring the credibility of qualitative stories but they are limited by current datasets for global crop production and trade, land use and hydrology. Climate change is likely to challenge the adaptive capacity of agricultural production and there are important knowledge gaps for modelling research to address

Design of a randomized controlled trial of physical training and cancer (Phys-Can) – the impact of exercise intensity on cancer related fatigue, quality of life and disease outcome

Background: Cancer-related fatigue is a common problem in persons with cancer, influencing health-related quality of life and causing a considerable challenge to society. Current evidence supports the beneficial effects of physical exercise in reducing fatigue, but the results across studies are not consistent, especially in terms of exercise intensity. It is also unclear whether use of behaviour change techniques can further increase exercise adherence and maintain physical activity behaviour. This study will investigate whether exercise intensity affects fatigue and health related quality of life in persons undergoing adjuvant cancer treatment. In addition, to examine effects of exercise intensity on mood disturbance, adherence to oncological treatment, adverse effects from treatment, activities of daily living after treatment completion and return to work, and behaviour change techniques effect on exercise adherence. We will also investigate whether exercise intensity influences inflammatory markers and cytokines, and whether gene expressions following training serve as mediators for the effects of exercise on fatigue and health related quality of life. Methods/design: Six hundred newly diagnosed persons with breast, colorectal or prostate cancer undergoing adjuvant therapy will be randomized in a 2 × 2 factorial design to following conditions; A) individually tailored low-to-moderate intensity exercise with or without behaviour change techniques or B) individually tailored high intensity exercise with or without behaviour change techniques. The training consists of both resistance and endurance exercise sessions under the guidance of trained coaches. The primary outcomes, fatigue and health related quality of life, are measured by self-reports. Secondary outcomes include fitness, mood disturbance, adherence to the cancer treatment, adverse effects, return to activities of daily living after completed treatment, return to work as well as inflammatory markers, cytokines and gene expression. Discussion: The study will contribute to our understanding of the value of exercise and exercise intensity in reducing fatigue and improving health related quality of life and, potentially, clinical outcomes. The value of behaviour change techniques in terms of adherence to and maintenance of physical exercise behaviour in persons with cancer will be evaluated

Transformations to groundwater sustainability: from individuals and pumps to communities and aquifers

If the success of agricultural intensification continues to rely on the depletion of aquifers and exploitation of (female) labour, transformations to groundwater sustainability will be impossible to achieve. Hence, the development of new groundwater imaginaries, based on alternative ways of organizing society-water relations is highly important. This paper argues that a comparative documentation of grass-roots initiatives to care for, share or recharge aquifers in places with acute resource pressures provides an important source of inspiration. Using a grounded anti-colonial and feminist approach, we combine an ethnographic documentation of groundwater practices with hydrogeological and engineering insights to enunciate, normatively assess and jointly learn from the knowledges, technologies and institutions that characterize such initiatives. Doing this usefully shifts the focus of planned efforts to regulate and govern groundwater away from government efforts to control individual pumping behaviours, to the identification of possibilities to anchor transformations to sustainability in collective action

Knowing Groundwater:Embodied Encounters with a Lively Resource

This paper is concerned with how water prospectors, well diggers, and irrigation farmers come to know groundwater. Drawing on cases from Tanzania and Zimbabwe, the paper shows that much knowledge is derived from the close encounters with groundwater that occur through hard physical work, mediated by the use of lowcost tools and technologies. In this paper we show how this knowledge is embedded in everyday livelihoods, landscapes, and moral ecological rationalities. Through empirical material of such close encounters with groundwater, we make two interrelated points. Firstly, we draw attention to the importance of embodied forms of knowledge in shaping engagements with groundwater. Frequent close physical interactions with groundwater generate rich and intimate understandings of the changing quality and quantity of water flows. These understandings become primary ways in which people in communities know water, which is lively and sometimes invisible. Secondly, we argue that, though apparently mundane, reliant on low-cost technology, and highly localised, these encounters significantly shape broader socio-natural relationships in emerging groundwater economies. Amongst other examples, our data show groundwater prospectors monitoring the depth of borehole drilling in a shared aquifer in an attempt to ensure equitable access for different users. In concluding the paper, we reflect on the extent to which the knowledge and relationships formed through close physical encounters with groundwater have the potential to shape trajectories of groundwater management

Who makes it all the way? Participants vs. decliners, and completers vs. drop-outs, in a 6-month exercise trial during cancer treatment. Results from the Phys-Can RCT

Purpose To compare sociodemographic, health- and exercise-related characteristics of participants vs. decliners, and completers vs. drop-outs, in an exercise intervention trial during cancer treatment. Methods Patients with newly diagnosed breast, prostate, or colorectal cancer were invited to participate in a 6-month exercise intervention. Background data for all respondents (n=2051) were collected at baseline by questionnaire and medical records. Additional data were collected using an extended questionnaire, physical activity monitors, and ftness testing for trial participants (n=577). Moreover, a sub-group of decliners (n = 436) consented to additional data collection by an extended questionnaire . Data were analyzed for between-group diferences using independent t-tests and chi2 -tests. Results Trial participants were younger (59±12yrs vs. 64±11yrs, p<.001), more likely to be women (80% vs. 75%, p=.012), and scheduled for chemotherapy treatment (54% vs. 34%, p<.001), compared to decliners (n=1391). A greater proportion had university education (60% vs 40%, p<.001), reported higher anxiety and fatigue, higher exercise self-efcacy and outcome expectations, and less kinesiophobia at baseline compared to decliners. A greater proportion of trial participants were classifed as ‘not physically active’ at baseline; however, within the group who participated, being “physically active” at baseline was associated with trial completion. Completers (n=410) also reported less kinesiophobia than drop-outs (n=167). Conclusion The recruitment procedures used in comprehensive oncology exercise trials should specifcally address barriers for participation among men, patients without university education and older patients. Individualized eforts should be made to enroll patients with low exercise self-efcacy and low outcome expectations of exercise. To retain participants in an ongoing exercise intervention, extra support may be needed for patients with kinesiophobia and those lacking healthenhancing exercise habits at baseline