Normative data for optic disc vertical cup-to-disc ratio and intraocular pressure in London 2012 competitors and support teams

Background / Aims The aims of this study were to identify normative values in vertical cup-to-disc ratio (CDR) and intraocular pressure (IOP) measurements in a unique sample of competitors and non-competitors at London 2012 according to continents and geographical sub-regions and find a suitable tool for mapping results across the world. Methods Data from all patients seen in the eye clinic for the London 2012 Olympic and Paralympic Games were used in this study. Patients were categorized into countries using the United Nations Geographical Sub-regions classification. All patients underwent a full optometric eye examination and clinical details including cup-to-disc ratio were recorded. Intraocular pressures were also recorded via non contact methods using the Topcon TRK-1P. Data was analyzed using R statistical software and SPSS. Continent and sub-continent level choropleth maps were produced using GGPlot2 package. Results Our study used a sample of 2,077 patients for analysis. The mean age across all the continents ranged from 43.44 years in the Americas to 47.11 years in Europe with an overall mean age of 45.12 (SD = 13.62 years). A CDR was recorded in 1,566 right eyes (OD). A Games-Howell post-hoc test revealed that Africa had statistically significantly larger CDRs (0.34 +/- 0.16) than both Europe (0.29 +/- 0.12, p = 0.00) and Asia (0.31, 0.15, p = 0.04) in this unique sample. In addition, within geographical sub-regions, Western Africa had statistically larger CDRs (0.36 +/- 0.18) than Western Asia (0.27 +/- 0.14, p = 0.02), Eastern Europe (0.29 +/- 0.12, p = 0.01) and Northern Europe (0.29 +/- 0.13, p = 0.03). A total of 1,621 IOP measurements were recorded for the right eye (OD). A Tukey post-hoc test revealed that Oceania had statistically lower IOPs (15.45 +/- 2.57) than Europe (16.93 +/- 2.98, p = 0.01), Asia (16.95 +/- 2.80, p = 0.01), the Americas (16.53 +/- 2.73, p = 0.02) and Africa (16.41 +/- 3.17, p = 0.05).Within geographical sub-regions, Northern Africa had statistically significantly lower IOPs (15.85 +/- 2.92) than Western Africa (17.18 +/- 2.97, p = 0.02), Western Asia (17.58 +/- 2.83, p = 0.04) and Eastern Europe (17.10 +/- 3.06, p = 0.02). Finally, our study found that competitors had significantly smaller CDRs (U = 66583.50, p = 0.01).and lower IOPs than noncompetitors (U = 79544.50, p = 0.01). Conclusions This is the first study to map out cup-to-disc ratio and intraocular pressure in a unique sample of competitors and non-competitors at London 2012 by continent and geographical sub-regions. The authors hope that this data may have benefits globally and that data from future Olympic and Paralympic Games can be added to this information to produce larger, more comprehensive data sets in the future

Phase II study to evaluate combining gemcitabine with flutamide in advanced pancreatic cancer patients

A phase II study was undertaken to determine the safety of combining flutamide with gemcitabine, with response rate being the primary end point. Twenty-seven patients with histologically proven, previously untreated, unresectable pancreatic adenocarcinoma received gemcitabine, 1 g m−2 intravenously on days 1, 8 and 15 of a 28 day cycle, and flutamide 250 mg given orally three times daily. Treatment was halted if there was unacceptable toxicity, or evidence of disease progression. Toxicity was documented every cycle. Tumour assessment was undertaken after cycles 2 and 4, and thereafter at least every additional four cycles. One hundred and seventeen cycles of treatment were administered, median four cycles per patient (range 1–18). Gemcitabine combined with flutamide was well tolerated, with most toxicities being recorded as grade 1 or 2 and only nine treatment cycles associated with grade 3 toxicity. The most frequent toxicity was myelosuppression. One case of transient jaundice was recorded. The commonest symptomatic toxicity was nausea and vomiting. The response rate was 15% (four partial responses), median survival 6 months and 22% of patients were alive at 1 year. These results suggest antitumour activity of the combination therapy to be equivalent to single agent gemcitabine

Vision and visual history in elite-/near-elite level cricketers and rugby-league players

Background: The importance of optimal and/or superior vision for participation in high-level sport remains the subject of considerable clinical research interest. Here we examine the vision and visual history of elite/near-elite cricketers and rugby-league players. Methods: Stereoacuity (TNO), colour vision, and distance (with/without pinhole) and near visual acuity (VA) were measured in two cricket squads (elite/international-level, female, n=16; near-elite, male, n=23) and one professional rugby-league squad (male, n=20). Refractive error was determined, and details of any correction worn and visual history were recorded. Results: Overall, 63% had their last eye-examination within 2 years. However, some had not had an eye examination for 5 years, or had never had one (near-elite-cricketers: 30%; rugby-league players: 15%; elite-cricketers: 6%). Comparing our results for all participants to published data for young, optimally-corrected, non-sporting adults, distance VA was ~1 line of letters worse than expected. Adopting α=0.01, the deficit in distance-VA deficit was significant, but only for elite-cricketers (p0.02 for all comparisons). On average, stereoacuity was better than in young adults, but only in elite-cricketers (p<0.001; p=0.03, near-elite-cricketers; p=0.47, rugby-league -players). On-field visual issues were present in 27% of participants, and mostly (in 75% of cases) comprised uncorrected ametropia. Some cricketers (near-elite: 17.4%; elite: 38%) wore refractive correction during play but no rugby-league player did. Some individuals with prescribed correction choose not to wear it when playing. Conclusion: Aside from near stereoacuity in elite-cricketers, these basic visual abilities were not better than equivalent, published data for optimally-corrected adults. 20-25% exhibited sub-optimal vision, suggesting that the clearest possible vision might not be critical for participation at the highest levels in the sports of cricket or rugby-league. Although vision could be improved in a sizeable proportion of our sample, the impact of correcting these, mostly subtle, refractive anomalies on playing performance is unknown

An evaluation of the effectiveness of a community mentoring service for socially isolated older people: a controlled trial

<p>Abstract</p> <p>Background</p> <p>Social isolation affects a significant proportion of older people and is associated with poor health outcomes. The current evidence base regarding the effectiveness of interventions targeting social isolation is poor, and the potential utility of mentoring for this purpose has not previously been rigorously evaluated. The purpose of this study was to examine the effectiveness of a community-based mentoring service for improving mental health, social engagement and physical health for socially isolated older people.</p> <p>Methods</p> <p>This prospective controlled trial compared a sample of mentoring service clients (intervention group) with a matched control group recruited through general practice. One hundred and ninety five participants from each group were matched on mental wellbeing and social activity scores. Assessments were conducted at baseline and at six month follow-up. The primary outcome was the Short Form Health Survey v2 (SF-12) mental health component score (MCS). Secondary outcomes included the SF-12 physical health component score (PCS), EuroQol EQ-5D, Geriatric Depression Score (GDS-10), social activity, social support and morbidities.</p> <p>Results</p> <p>We found no evidence that mentoring was beneficial across a wide range of participant outcomes measuring health status, social activity and depression. No statistically significant between-group differences were observed at follow-up in the primary outcome (p = 0.48) and in most secondary outcomes. Identifying suitable matched pairs of intervention and control group participants proved challenging.</p> <p>Conclusions</p> <p>The results of this trial provide no substantial evidence supporting the use of community mentoring as an effective means of alleviating social isolation in older people. Further evidence is needed on the effectiveness of community-based interventions targeting social isolation. When using non-randomised designs, there are considerable challenges in the recruitment of suitable matches from a community sample.</p> <p>Trial registration</p> <p>SCIE Research Register for Social Care 105923</p

Physical activity levels in adults and older adults 3–4 years after pedometer-based walking interventions: Long-term follow-up of participants from two randomised controlled trials in UK primary care

Background Physical inactivity is an important cause of noncommunicable diseases. Interventions can increase short-term physical activity (PA), but health benefits require maintenance. Few interventions have evaluated PA objectively beyond 12 months. We followed up two pedometer interventions with positive 12-month effects to examine objective PA levels at 3–4 years. Methods and findings Long-term follow-up of two completed trials: Pedometer And Consultation Evaluation-UP (PACE-UP) 3-arm (postal, nurse support, control) at 3 years and Pedometer Accelerometer Consultation Evaluation-Lift (PACE-Lift) 2-arm (nurse support, control) at 4 years post-baseline. Randomly selected patients from 10 United Kingdom primary care practices were recruited (PACE-UP: 45–75 years, PACE-Lift: 60–75 years). Intervention arms received 12-week walking programmes (pedometer, handbooks, PA diaries) postally (PACE-UP) or with nurse support (PACE-UP, PACE-Lift). Main outcomes were changes in 7-day accelerometer average daily step counts and weekly time in moderate-to-vigorous PA (MVPA) in ≥10-minute bouts in intervention versus control groups, between baseline and 3 years (PACE-UP) and 4 years (PACE-Lift). PACE-UP 3-year follow-up was 67% (681/1,023) (mean age: 59, 64% female), and PACE-Lift 4-year follow-up was 76% (225/298) (mean age: 67, 53% female). PACE-UP 3-year intervention versus control comparisons were as follows: additional steps/day postal +627 (95% CI: 198–1,056), p = 0.004, nurse +670 (95% CI: 237–1,102), p = 0.002; total weekly MVPA in bouts (minutes/week) postal +28 (95% CI: 7–49), p = 0.009, nurse +24 (95% CI: 3–45), p = 0.03. PACE-Lift 4-year intervention versus control comparisons were: +407 (95% CI: −177–992), p = 0.17 steps/day, and +32 (95% CI: 5–60), p = 0.02 minutes/week MVPA in bouts. Neither trial showed sedentary or wear-time differences. Main study limitation was incomplete follow-up; however, results were robust to missing data sensitivity analyses. Conclusions Intervention participants followed up from both trials demonstrated higher levels of objectively measured PA at 3–4 years than controls, similar to previously reported 12-month trial effects. Pedometer interventions, delivered by post or with nurse support, can help address the public health physical inactivity challenge