Duration of the Effects of Three Static Stretching Conditions With or Without a Dynamic Warm-Up in College Age Adults

Purpose. The purpose of this study was to determine the stretching duration (15, 30, 60 seconds) with or without a dynamic warm-up that resulted in the longest lasting acute effects in hamstring flexibility. Subjects. Forty subjects (17 male, 23 female) (age: 20-35 years) were selected to participate in this study using a sample of convenience from university graduate students. Methods. This study contained 7 treatment conditions in which each subject completed in random order. Three groups consisted of a 5-minute treadmill warm-up at a self-selected velocity (SSV) followed by one of three stretching durations (15, 30, or 60 sec). Three other groups consisted of only one of the three stretching conditions without the treadmill warm-up. The final group consisted of only walking for 5 min on the treadmill at SSV without receiving a static stretch. A baseline passive knee extension range of motion (ROM) was taken in supine followed by the stretching/treadmill intervention. Subsequent knee ROM measurements were taken each minute until knee ROM returned to baseline. Results. The presence of treadmill warm-up resulted in significantly greater duration of increased hamstring ROM (p≤0.0005). Within the four treadmill conditions, there was no significant difference in duration of increased hamstring ROM. There was no observed statistically significant difference among the three static stretch groups with no treadmill warm-up as well. Conclusion. The results suggest that a dynamic warm-up with or without a static stretch led to the longest duration of acute increase in hamstring ROM

Harms with placebo in trials of biological therapies and small molecules as maintenance therapy in inflammatory bowel disease: a systematic review and meta-analysis

BackgroundRandomised placebo-controlled trials for the induction of inflammatory bowel disease (IBD) remission involve potential harms to those receiving placebo. Whether these harms are also apparent with placebo during maintenance of remission trials in IBD is unclear. We aimed to examine the potential harms associated with receiving placebo in trials of licensed biologics and small molecules for maintenance of remission of ulcerative colitis and luminal Crohn's disease in a meta-analysis.MethodsWe performed a systematic review and meta-analysis. We searched several medical literature databases including MEDLINE (from Jan 1, 1946, to May 31, 2024), Embase and Embase Classic (Jan 1, 1947, to May 31, 2024), and the Cochrane Central Register of Controlled Trials from database inception to May 31, 2024, for randomised placebo-controlled trials of licensed biologics and small molecules for maintenance of remission in adults with IBD reporting data on adverse events over a period of 20 weeks or more. There were no language restrictions or prespecified exclusion criteria. We extracted summary data and pooled data using a random-effects model for any treatment-emergent adverse event, drug-related adverse event, infection, worsening of IBD activity, withdrawal due to adverse events, serious adverse events, serious infection, serious worsening of IBD activity, or venous thromboembolic events, reporting relative risks (RRs) for placebo versus active drug with 95% CIs for each outcomes. The protocol for this meta-analysis was registered with PROSPERO (CRD42024542624).FindingsOur search identified 10 826 citations, of which 45 trials including 16 562 patients (10 319 [62·3%] receiving active drug and 6243 [37·7%] placebo) were eligible. The risks of any treatment-emergent adverse event (7297/9546 [76·4%] patients on active drug vs 4415/5850 [75·5%] on placebo; RR 1·01, 95% CI 0·99–1·04; I2 =47%), serious infection (260/10 242 [2·5%] vs 155/6149 [2·5%]; 0·97, 0·79–1·19; I2 =0%), or venous thromboembolic event (12/4729 [0·3%] vs 9/2691 [0·3%]; 0·72, 0·31–1·66; I2 =0%) were not significantly lower with active drug than placebo. The risks of any infection (3208/8038 [39·9%] vs 1713/4809 [35·6%]; 1·14, 1·05–1·23; I2 =60%) or any drug-related adverse event (1094/2997 [36·5%] vs 609/1950 [31·2%]; 1·24, 1·02–1·50; I2 =75%) were higher with active drug than placebo. However, the risks of any worsening of IBD activity (1038/8090 [12·8%] vs 1181/5191 [22·8%]; 0·58, 0·52–0·64; I2 =40%), any withdrawal due to adverse events (610/10 282 [5·9%] vs 561/6207 [9·0%]; 0·71, 0·60–0·84; I2 =43%), any serious adverse events (1066/10 292 [10·4%] vs 742/6198 [12·0%]; 0·85, 0·77–0·94; I2 =17%), or any serious worsening of IBD activity (101/5707 [1·8%] vs 143/3640 [3·9%]; 0·55, 0·42–0·71; I2 =0%) were lower with active drug than placebo. 21 randomised controlled trials were judged as low risk of bias across all domains.InterpretationIn maintenance of remission trials in IBD, placebo was associated with some clinically significant potential harms. Patients should be counselled about these before participating in clinical trials and consideration given to alternative designs to test novel drugs in IBD

Assessment of the quality of online patient information resources for patients considering parastomal hernia treatment

Aim: The aim was to examine the quality of online patient information resources for patients considering parastomal hernia treatment.Methods: A Google search was conducted using lay search terms for patient facing sources on parastomal hernia. The quality of the content was assessed using the validated DISCERN instrument. Readability of written content was established using the Flesch–Kincaid score. Sources were also assessed against the essential content and process standards from the National Institute for Health and Care Excellence (NICE) framework for shared decision making support tools. Content analysis was also undertaken to explore what the sources covered and to identify any commonalities across the content.Results: Fourteen sources were identified and assessed using the identified tools. The mean Flesch–Kincaid reading ease score was 43.61, suggesting that the information was difficult to read. The overall quality of the identified sources was low based on the pooled analysis of the DISCERN and Flesch–Kincaid scores, and when assessed against the criteria in the NICE standards framework for shared decision making tools. Content analysis identified eight categories encompassing 59 codes, which highlighted considerable variation between sources.Conclusions: The current information available to patients considering parastomal hernia treatment is of low quality and often does not contain enough information on treatment options for patients to be able to make an informed decision about the best treatment for them. There is a need for high-quality information, ideally co-produced with patients, to provide patients with the necessary information to allow them to make informed decisions about their treatment options when faced with a symptomatic parastomal hernia

Exploring the Longitudinal Relationship Between Short Sleep Duration, Temperament and Attention Deficit Hyperactivity Disorder Symptoms in a Biethnic Population of Children Aged Between 6 and 61 Months:A Born in Bradford Study

Objective: Examine the association between sleep duration, temperament and symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in a biethnic child-population from The Born in Bradford cohort. Method: Parent-report sleep duration categorized children as: early short, late short, consistently short or consistently normal sleepers between 6 and 36 months. Temperament was measured using the Infant Characteristics Questionnaire at 6 months. The Strengths and Difficulties Questionnaire assessed symptoms of ADHD at 37, 54, and 61 months. Results: Normal sleepers before 18 months had significantly fewer ADHD symptoms at 37 months compared with consistently short sleepers. Fussiness at 6 months was significantly positively associated with ADHD symptoms at 37 and 54 months; but does not appear to mediate the relationship between sleep duration and ADHD symptoms. Conclusion: Awareness of the relationship between short sleep duration and fussiness in infancy and later ADHD symptomatology may support earlier identification of arising difficulties in children

Evidence for Height and Immune Function Trade-offs Among Preadolescents in a High Pathogen Population

Background In an energy-limited environment, caloric investments in one characteristic should trade-off with investments in other characteristics. In high pathogen ecologies, biasing energy allocation towards immune function over growth would be predicted, given strong selective pressures against early-life mortality. Methodology In the present study, we use flow cytometry to examine trade-offs between adaptive immune function (T cell subsets, B cells), innate immune function (natural killer cells), adaptive to innate ratio and height-for-age z scores (HAZ) among young children (N = 344; aged 2 months–8 years) in the Bolivian Amazon, using maternal BMI and child weight-for-height z scores (WHZ) as proxies for energetic status. Results Markers of adaptive immune function negatively associate with child HAZ, a pattern most significant in preadolescents (3+ years). In children under three, maternal BMI appears to buffer immune and HAZ associations, while child energetic status (WHZ) moderates relationships in an unexpected direction: HAZ and immune associations are greater in preadolescents with higher WHZ. Children with low WHZ maintain similar levels of adaptive immune function, but are shorter compared to high WHZ peers. Conclusions Reduced investment in growth in favor of immunity may be necessary for survival in high pathogen contexts, even under energetic constraints. Further, genetic and environmental factors are important considerations for understanding variation in height within this population. These findings prompt consideration of whether there may be a threshold of investment into adaptive immunity required for survival in high pathogen environments, and thus question the universal relevance of height as a marker of health. Lay Summary Adaptive immune function is negatively associated with child height in this high pathogen environment. Further, low weight-for-height children are shorter but maintain similar immune levels. Findings question the relevance of height as a universal health marker, given that costs and benefits of height versus immunity may be calibrated to local ecology

Modernization, Sexual Risk-Taking, and Gynecological Morbidity Among Bolivian Forager-Horticulturalists

Sexual risk-taking and reproductive morbidity are common among rapidly modernizing populations with little material wealth, limited schooling, minimal access to modern contraception and healthcare, and gendered inequalities in resource access that limit female autonomy in cohabiting relationships. Few studies have examined how modernization influences sexual risk-taking and reproductive health early in demographic transition. Tsimane are a natural fertility population of Bolivian forager-farmers; they are not urbanized, reside in small-scale villages, and lack public health infrastructure. We test whether modernization is associated with greater sexual risk-taking, report prevalence of gynecological morbidity (GM), and test whether modernization, sexual risk-taking and parity are associated with greater risk of GM. Data were collected from 2002–2010 using interviews, clinical exams, and laboratory analysis of cervical cells. We find opposing effects of modernization on both sexual risk-taking and risk of GM. Residential proximity to town and Spanish fluency are associated with greater likelihood of men’s infidelity, and with number of lifetime sexual partners for men and women. However, for women, literacy is associated with delayed sexual debut after controlling for town proximity. Fifty-five percent of women present at least one clinical indicator of GM (n = 377); 48% present inflammation of cervical cells, and in 11% the inflammation results from sexually transmitted infection (trichomoniasis). Despite having easier access to modern healthcare, women residing near town experience greater likelihood of cervical inflammation and trichomoniasis relative to women in remote villages; women who are fluent in Spanish are also more likely to present trichomoniasis relative to women with moderate or no fluency. However, literate women experience lower likelihood of trichomoniasis. Parity has no effect on risk of GM. Our results suggest a net increase in risk of reproductive morbidity among rapidly modernizing, resource-stressed populations

Studies to assess the effect of pet training aids specifically remote static pulse systems on the welfare of domestic dogs

This project assessed the welfare of dogs trained with pet training aids, specifically remote static pulse collar systems (e-collars). Previous work has focused on a very limited number of devices in a very limited range of contexts and the evidence of the impact of such devices on dog's overall quality of life is inconclusive. Project AW1402 aimed to assess the physical characteristics of the e-collars and the physiological, behavioural and psychological consequences of their use in dog training in four objectives. 1. Investigate the resistance in the neck skin of a range of dogs 2. Measure the physical output properties of the devices under investigation 3. Evaluate methods for recording behavioural/psychological measures of emotional state in the context of dog training. 4. Investigate the long term behavioural, physiological and psychological effects of using training devices in the domestic dog A representative selection of e-collars was purchased to allow the assessment of electrical properties in laboratory tests and the evaluation of manuals (Objective 2). As the electrical output of the e-collars depended on the impedance presented by the dogs' necks, this was measured first on a sample of dogs of a number of breed and cross-breeds under dry and wet conditions (Objective 1). This was done under supervision of an animal welfare specialist and did not cause pain or distress as indicative from the dogs' behaviours. The impedance of dogs can be modelled as a passive resistance with a value of about 10kΩ (10th -90th percentile range 4 – 150kΩ) for wet dogs and 600kΩ (22 – 950kΩ) for dry dogs. The momentary stimulus generated by the e-collars comprised a sequence of identical short voltage pulses. The continuous stimulus comprised a much longer sequence of the same voltage pulses. There were considerable differences between tested e-collar models in the voltages, the number of pulses in, and length of each stimulus, but little variation within individual models of e-collars. The peak voltage delivered by e-collars varied significantly with the resistance of the dog, from as much as 6000V at 500kΩ to 100V at 5kΩ. The highest voltages were generated for only a few millionths of a second. To allow meaningful comparisons between e-collars (taking into account the differences in electrical characteristics), a stimulus strength ranking indicator (SSRI) was developed. This showed differences between the selected e-collars, as well as differences in the relationship between momentary and continuous stimuli. Manuals were clear on operation, but gave varying levels of information on using the e-collar in training. Generally they did not adequately explain their full potential, for instance with respect to using the tone or vibrate functions. Advice in manuals was not always taken up by end-users as evident from responses in owner questionnaire collected as part of objectives 3 and 4. A pilot study involving 10 dogs with prior experience of e-collars and 10 control dogs (matched by age, sex, breed and where possible behavioural problem) was conducted to develop and evaluate protocols for assessing dog welfare in home and training environments (Objective 3). This was followed by a larger field study (Objective 4) involving 65 dogs with prior experience of e-collar training and 65 matched controls. Cases and matched controls for Objective 4 were initially recruited from a separate training methods survey distributed to dog owners to reduce sampling bias, but this was later supplemented by other recruitment methods. Data collection in Objective 4 included:- 1. An owner questionnaire to collect demographic data on dogs and owners; and owner-reports of behaviour during training and efficacy of training methods. 2. First passage urine to measure cortisol, creatinine, and metabolites of the neuro-transmitters serotonin (5-HIAA) and dopamine (HVA). 3. Saliva for assay of cortisol prior to and during training. 4. Observations of dog behaviour during fitting of inactivated e-collar 5. Observation of dog behaviours during a series of standard training tasks (“stay”, “leave” and “recall” and the situation for which the focal device was used) given by both owner and a researcher and conducted in the context where the focal device had been originally used for training. Each set of tests were repeated both without (Test 1) and with (Test 2) the wearing of a dummy or inactivated e-collar to enable comparisons to be made between measures for the same dogs when wearing an e-collar (which may predict the application of stimulus for the dog) and not. 6. A spatial discrimination task designed to use judgement bias to assess underlying affective state. Questionnaire data included type of device used, time since use, owner perceptions of the success of training, and owner reports of behavioural responses to use. Training methods used by owners in the control group could be sub-divided into those mainly using positive reinforcement (reward based) training, and those using methods based largely on punishment or negative reinforcement. Most owners (68%) purchased e-collars new, mainly from the internet, though some owners borrowed or purchased second hand collars. Problems with recall (40%) and livestock worrying (33%) accounted for the majority of reasons for e-collars use, although some manuals included information on use for basic obedience. Owner reports on operation of devices suggested they were often unclear as to how best use e-collars in training and some appeared not to have followed manual advice (if available). 36% of owners reported vocalisations on first use, and 26% on subsequent use of e-collars. This suggested that operating levels may not have been set in accordance with manufacturer’s instruction (where available), though due to owners often being unable to recall how they used the device this could not always be verified. Owners reported the addressed behaviours to be more severe in e-collar trained dogs than the controls. Owners showed a high degree of satisfaction with the effectiveness of all the training approaches used, though owners from the e-collar group were more likely to state they would prefer to try other forms of training in the future. No significant differences between groups were identified for behaviours shown during collar fitting, although a wide range of behavioural responses among dogs were noted. These differences were considered likely to reflect response to novelty in the control group, and the specific events that usually followed collar fitting in the e-collar group such no consequence, going for a walk or stimulus application. Because of high variability between dogs, it was considered that differences in measures between the first series of training tasks (Test 1; conducted with no collar) and the second series of training tasks (Test 2; conducted with dogs wearing a dummy collar) would be more reliable than absolute differences between groups. There was a significant increase in salivary cortisol between tests in the e-collar group compared to the sub-group of dogs trained using positive reinforcement. A behavioural scale incorporating proportion of training period tense, an inverse of proportion of training time relaxed, and proportion of time with attention directed at owner (whoever was training) significantly increased in the e-collar group, as compared to both the whole control group and the sub-set of dogs predominantly trained using positive reinforcement. These differences may reflect increased emotional arousal in e-collar dogs as a result of previous learned associations with the collar. Data was collected for a further 11 control dogs who experienced both sets of standard training tasks but wearing no collar to test for potential order effects. Their behavioural and physiological responses were consistent with control dogs who wore the e-collar for the second set of tasks. There was some evidence of higher baseline cortisol in control dogs compared with e-collar dogs in both the urinary cortisol: creatinine (reflecting cortisol production overnight before researcher arrival) and baseline salivary cortisol (taken after the arrival of the researcher and likely to be influenced by the events associated with visitor arrival and greeting) particularly when considering just the positive reinforcement sub-group. However these differences were small and found not to be significant when a multiple comparison Bonferroni correction was applied. There were no significant differences in neurotransmitter metabolites between the two groups. Neither were there significant differences between control and e-collar dogs with respect to speed to ambiguous probes in the judgement bias task. However, in the latter case, group effects were confounded by strong effects of arena size where different test spaces had been used. Overall, this project has highlighted the very variable outcomes between individual dogs when trained using e-collars. The combination of differences in individual dog’s perception of stimuli, different stimulus strength and characteristics from collars of different brands, differences between momentary and continuous stimuli, differences between training advice in manuals, differences in owner understanding of training approaches and how owners use the devices in a range of different circumstances are likely to lead to a wide range of training experiences for pet dogs. This variability in experience is evidenced in the data from trained dogs such as owner reports of their dogs’ response to e-collar use. Significant differences were, however, found in data collected from e-collar and control dogs undergoing standard training tests with and without dummy e-collars. These included a difference in the change in salivary cortisol between tests with e-collar dogs showing an increase and positive reinforcement dogs showing a lowering of salivary cortisol between the tests. There were also behavioural changes that were consistent with changes in emotional state, with e-collar dogs showing an increase in a behavioural scale incorporating time spent tense and the inverse of time relaxed between the two situations. These training tasks were designed as far as possible to replicate the context where e-collar training had occurred in the past, and indicate a shift towards higher levels of physiological and behavioural arousal in the e-collar dogs as well as a tendency to focus more on the owner than when they had not been wearing a collar. Thus it seems reasonable to conclude that the previous use of e-collars in training is associated with behavioural and physiological responses that are consistent with negative emotional states. It is therefore suggested that the use of e-collars in training pet dogs leads to a negative impact on welfare, at least in a proportion of animals trained using this technique

Depression as Sickness Behavior? A Test of the Host Defense Hypothesis in a High Pathogen Population

Sadness is an emotion universally recognized across cultures, suggesting it plays an important functional role in regulating human behavior. Numerous adaptive explanations of persistent sadness interfering with daily functioning (hereafter “depression”) have been proposed, but most do not explain frequent bidirectional associations between depression and greater immune activation. Here we test several predictions of the host defense hypothesis, which posits that depression is part of a broader coordinated evolved response to infection or tissue injury (i.e. “sickness behavior”) that promotes energy conservation and reallocation to facilitate immune activation. In a high pathogen population of lean and relatively egalitarian Bolivian foragerhorticulturalists, we test whether depression and its symptoms are associated with greater baseline concentration of immune biomarkers reliably associated with depression in Western populations (i.e. tumor necrosis factor alpha [TNF-α], interleukin-1 beta [IL-1β], interleukin-6 [IL-6], and C-reactive protein [CRP]). We also test whether greater pro-inflammatory cytokine responses to ex vivo antigen stimulation are associated with depression and its symptoms, which is expected if depression facilitates immune activation. These predictions are largely supported in a sample of older adult Tsimane (mean±SD age=53.2±11.0, range=34-85, n=649) after adjusting for potential confounders. Emotional, cognitive and somatic symptoms of depression are each associated with greater immune activation, both at baseline and in response to ex vivo stimulation. The association between depression and greater immune activation is therefore not unique to Western populations. While our findings are not predicted by other adaptive hypotheses of depression, they are not incompatible with those hypotheses and future research is necessary to isolate and test competing predictions

Immune Function During Pregnancy Varies Between Ecologically Distinct Populations

Background and objectives Among placental mammals, females undergo immunological shifts during pregnancy to accommodate the fetus (i.e. fetal tolerance). Fetal tolerance has primarily been characterized within post-industrial populations experiencing evolutionarily novel conditions (e.g. reduced pathogen exposure), which may shape maternal response to fetal antigens. This study investigates how ecological conditions affect maternal immune status during pregnancy by comparing the direction and magnitude of immunological changes associated with each trimester among the Tsimane (a subsistence population subjected to high pathogen load) and women in the USA. Methodology Data from the Tsimane Health and Life History Project (N = 935) and the National Health and Nutrition Examination Survey (N = 1395) were used to estimate population-specific effects of trimester on differential leukocyte count and C-reactive protein (CRP), a marker of systemic inflammation. Results In both populations, pregnancy was associated with increased neutrophil prevalence, reduced lymphocyte and eosinophil count and elevated CRP. Compared to their US counterparts, pregnant Tsimane women exhibited elevated lymphocyte and eosinophil counts, fewer neutrophils and monocytes and lower CRP. Total leukocyte count remained high and unchanged among pregnant Tsimane women while pregnant US women exhibited substantially elevated counts, resulting in overlapping leukocyte prevalence among all third-trimester individuals. Conclusions and implications Our findings indicate that ecological conditions shape non-pregnant immune baselines and the magnitude of immunological shifts during pregnancy via developmental constraints and current trade-offs. Future research should investigate how such flexibility impacts maternal health and disease susceptibility, particularly the degree to which chronic pathogen exposure might dampen inflammatory response to fetal antigens. Lay Summary This study compares immunological changes associated with pregnancy between the Tsimane (an Amazonian subsistence population) and individuals in the USA. Results suggest that while pregnancy enhances non-specific defenses and dampens both antigen-specific immunity and parasite/allergy response, ecological conditions strongly influence immune baselines and the magnitude of shifts during gestation