Exercise epigenetics and the foetal origins of disease

Exercise epigenetics is a nascent area of research with vast health implications (e.g., from the treatment of obesity-related diseases to beneficially decoupling epigenetic and chronological age). Evidence is accumulating [1] that exercise can acutely modify the epigenome (e.g., via DNA methylation) for short-term regulatory purposes (e.g., mRNA expression). More speculatively perhaps, maternal exercise during the pre and post–partum period could cause epigenetic changes in offspring. It is generally believed that there are benefits of regular moderate exercise during pregnancy [2]. The phenotypic benefits of maternal exercise notwithstanding, exercise can be viewed as a type of organismal stressor [1]. There are a myriad of ways in which environmental perturbations can affect foetal development. For example gestational stress could alter the epigenome and subsequent physical development. We suggest that maternal exercise -- like most gestational stressors -- will have a dose-response relationship on an offspring’s epigenome (i.e., negative effects at high doses), akin to the phenomenon of hormesis. Interestingly there is no research investigating the epigenetic effects of maternal exercise in humans. This editorial is a call for research on the subject

The impact of minor injury unit closures on travel time and attendances

This is the author accepted manuscript. The final version is available from Mark Allen Healthcare via the DOI in this record Data availability: An anonymised version of the full data used to parameterise the model, along with the full outputs of the model, may be provided on request.Geographic modelling techniques provide a means of optimising the location of services, or understanding the potential impact of geographic service reconfigurations. In response to commissioner queries, we assessed the potential impact on patient travel time and attendances of the closure of four minor injury units (MIUs) in a locality of South West England. We used the MPMileCharter add-in for Microsoft MapPoint and the attendance records of 90252 minor injury unit patients to calculate car travel time data to the units in the locality. We then built a geographic model of the existing configuration of MIUs in Microsoft Excel, and used 'what if' analysis to determine the potential impact of the proposed closures. The model predicted that if the four MIUs were closed, there would be only a trivial increase in average travel time across all patients, but a significant increase of around 20 minutes per patient for those whose nearest unit was closed. The model also predicted that the closure of one of the MIUs could lead to significant increased demand at the walk-in centre located at the acute hospital. Using these results, the local commissioners decided to close only three of the four units.National Institute for Health Research (NIHR

Guidelines on glaucoma and the demand for services

This is the author accepted manuscript. The final version is available from Mark Allen Healthcare via the DOI in this record The authors produced a seasonalised forecast using a linear regression trendline to predict the level of demand for ophthalmology services at Royal Devon and Exeter hospital between 2013 and 2017. The model predicts an average annual increase in demand of 9.92%, but a significant proportion of this predicted increased demand is for glaucoma services. Given the historical patterns of demand observed in the data, it is possible that the increases in demand for glaucoma services have arisen because of dramatically increased referral rates from community optometrists, following the publication by the National Institute for Clinical Excellence (NICE) of clinical guidelines on the diagnosis and management of glaucoma and ocular hypertension (NICE, 2009). As this patient cohort may be best served by assessment outside of secondary care, we would encourage other hospital managers and analysts to produce similar forecasts and consider alternative pathways of care for this patient group

Fractured neck of femur patients: Rehabilitation and the acute hospital

This is the author accepted manuscript. The final version is available from Mark Allen Healthcare via the DOI in this record Typically, fractured neck of femur patients admitted to an acute hospital are discharged to a community hospital for a period of rehabilitation after their treatment. However, there is concern that this might unnecessarily extend the total period of hospitalisation for these patients. Using data from a local acute hospital, we used discrete event simulation to predict the practicability of fractured neck of femur patients remaining in an acute hospital for their entire superspell (the overall length of stay across hospitals). We tested scenarios in which patient superspell duration was shortened, as well as a scenario in which no reduction in superspell length was observed. The model predicts that - even assuming that the superspell of fractured neck of femur patients could be significantly reduced - bed occupancy levels at the acute hospital would increase to operationally infeasible levels. Therefore, it is unlikely that fractured neck of femur patients could remain in a typical acute hospital unless there were sufficient increases in available resources.National Institute for Health Research (NIHR

Cost-effectiveness of bevacizumab for diabetic macular oedema

This is the author accepted manuscript. The final version is available from Mark Allen Healthcare via the DOI in this record A Markov model was developed to predict the outcomes and cost-effectiveness of bevacizumab compared to macular laser therapy for diabetes patients with clinically significant macular oedema (CSMO). This study used outcome data from a randomised controlled trial, utility data and health states from a ranibizumab health technology assessment, and costs from the UK national tariff. A total of 37.73% of patients treated with bevacizumab in the model had a visual acuity of at least 76 Early Treatment Diabetic Retinopathy Study Research Group (ETDRS) letters after four years, compared with 4.09% of laser therapy patients. Only 0.11% of bevacizumab patients were blind after four years compared with 6.45% of laser therapy patients. However, with an incremental cost-effectiveness ratio of £51,182, we predict that bevacizumab would not be cost-effective compared to laser therapy because of the influence of the NHS national tariff costs for monitoring patients and administering bevacizumab, and the inability of the EQ-5D measure to capture the impact of sensory deprivation on quality of life sufficiently. This study recommends significant caution when interpreting the results of cost-effectiveness analyses of interventions that involve vision-related interventions.National Institute for Health Research (NIHR

Which factors most influence demand for ambulances in South West England?

This is the author accepted manuscript. The final version is available from Mark Allen Healthcare via the DOI in this record Ambulance demand in South West England is increasing year-on-year, but the driving forces behind such increases are poorly understood. We developed a system dynamics model to simulate the factors that influence a call being made for an ambulance. We used data from the South West Ambulance Service NHS Foundation Trust (SWAST), the Office of National Statistics (ONS) and quantitative relationship data in both national and international literature to parameterise the model. We compared predicted ambulance demand over 12 months in the base case model with scenarios in which each influencing factor was removed in turn. The model predicts that the prevalence of regular falls among older people most influences the level of demand for ambulances. The model also predicts that the number of users of adult mental health services could be a significant contributor to ambulance demand. Additional focus on, and investment in, falls prevention strategies could help to significantly alleviate increasing levels of demand for ambulance services in South West England. Additionally, efforts to understand why those with mental health needs tend to use ambulances more than those without such needs could also be beneficial.National Institute for Health Research (NIHR

Can the retinal screening interval be safely increased to 2 years for type 2 diabetic patients without retinopathy?

This is the final version. Available from American Diabetes Association via the DOI in this recordOBJECTIVE: In the U.K., people with diabetes are typically screened for retinopathy annually. However, diabetic retinopathy sometimes has a slow progression rate. We developed a simulation model to predict the likely impact of screening patients with type 2 diabetes, who have not been diagnosed with diabetic retinopathy, every 2 years rather than annually. We aimed to assess whether or not such a policy would increase the proportion of patients who developed retinopathy-mediated vision loss compared with the current policy, along with the potential cost savings that could be achieved. RESEARCH DESIGN AND METHODS: We developed a model that simulates the progression of retinopathy in type 2 diabetic patients, and the screening of these patients, to predict rates of retinopathy-mediated vision loss. We populated the model with data obtained from a National Health Service Foundation Trust. We generated comparative 15-year forecasts to assess the differences between the current and proposed screening policies. RESULTS The simulation model predicts that implementing a 2-year screening interval for type 2 diabetic patients without evidence of diabetic retinopathy does not increase their risk of vision loss. Furthermore, we predict that this policy could reduce screening costs by ~25%. CONCLUSIONS: Screening people with type 2 diabetes, who have not yet developed retinopathy, every 2 years, rather than annually, is a safe and cost-effective strategy. Our findings support those of other studies, and we therefore recommend a review of the current National Institute for Health and Clinical Excellence (NICE) guidelines for diabetic retinopathy screening implemented in the U.K.National Institute for Health Research (NIHR

Occupational possible selves: patterns among male and female undergraduates

This study uses the possible selves theory (Markus & Nurius, 1986) to examine the differences between 27 undergraduate men and 27 undergraduate women in their perceptions of their future occupational possibilities. Participants rated a list of feminine, masculine, and neutral jobs on how much they feared, expected, and idealized each one. Analysis was done using a within-subjects repeated measures MANOVA test and backward elimination regression analysis. Both men and women were found to fear feminine jobs more than they expected or idealized these jobs (all ps \u3c .001). Women were found to fear masculine jobs more than they expected (p \u3c .001) but not more than they idealized these jobs (p \u3c .060). Occupational self-efficacy and support of the women\u27s movement were also analyzed for their possible influence on fear of masculine jobs, using the Attitudes Toward Feminism and the Women\u27s Movement Scale and the Task-Specific Scale of Occupational Self-Efficacy, but no significant predictors were found