Perceived environment and physical activity: a meta-analysis of selected environmental characteristics

BACKGROUND: Several narrative reviews have been conducted on the literature examining environmental correlates of physical activity (PA). To date these reviews have been unable to provide definitive summaries of observed associations. This study utilizes meta-analytical techniques to calculate summaries of associations between selected environmental characteristics and PA. METHODS: Published studies were identified from electronic databases and searches of personal files. Studies were examined to determine the environmental constructs most frequently studied. Included studies (N = 16) examined at least one identified construct and determined associations between perceived environmental constructs and PA using logistic regression. Data were analyzed separately for crude and adjusted ORs using general-variance based fixed effect models. RESULTS: No significant associations emerged between environmental characteristics and PA using crude OR. The perceived presence of PA facilities (OR 1.20, 95% 1.06–1.34), sidewalks (OR 1.23, 95% 1.13–1.32), shops and services (OR 1.30, 95% 1.14–1.46) and perceiving traffic not to be a problem (OR 1.22, 95% 1.08–1.37) were positively associated with activity using adjusted ORs. Variance in PA accounted for by significant associations ranged from 4% (heavy traffic not a problem) to 7% (presence of shops and services). CONCLUSION: Results of the meta-analysis support the relevance of perceived environmental characteristics for understanding population PA. These results should encourage the use of comprehensive ecological models that incorporate variables beyond basic demographic information

Injections of hope: supporting participants in clinical trials

Understanding hope and better appreciating the personal investments of trial participants could improve patient experience and trial design, argue Emma Harding, Catherine Mummery, and colleague

Reporting on training developed for pharmacy assistants and pharmacy dispensary technicians working with Medication Assisted Treatment for Opioid Dependence (MATOD) consumers in regional Victoria

A recent study (Patil et al., 2018) analysing lived experiences of Medication Assisted Treatment for Opioid Dependence (MATOD) consumers suggested that some experienced discrimination and stigma in the pharmacy context in regional Victoria, Australia. One of the recommendations was to explore professional training and education opportunities for allied health professionals and in particular, Pharmacy Assistants (PAs) and Pharmacy Dispensary Technicians (PDTs) as they are integral to serving MATOD consumers. Ballarat Community Health commissioned Federation University to develop training modules for PAs and PDTs working in the pharmacy settings in regional Victoria. A survey of the literature identified two key issues, namely, the lack of professional education and training of PAs and PDTs involved in serving the consumers in pharmacy settings either at the national or state level in Australia. The other finding was the varied use of different types of ‘opioid dependence’ treatments in different jurisdictions of Australia which had implications in terms of embedding psychosocial or Social Determinants of Health (SDH) with therapeutic treatments. As a result, this project serves as a significant step in employing SDH based training modules for PAs and PDTs working with MATOD consumers in the pharmacy settings to address stigma and discrimination. The training workshop materials will be evaluated to determine its efficacy in terms of change of attitudes and professional practice. The aim of this study is to: 1. Deliver and evaluate a new professional training module concerning MATOD and; 2. Examine and evaluate the efficacy and impact of the training module on professional practice and changes in attitudes towards stigma and discrimination amongst PAs and PDTs. This project was conducted in two stages. At the first stage, two workshops (each lasting for two hours) were delivered in two different regional locations in the state of Victoria, Australia (referred to as locations A and B in this report). Thirteen participants expressed interest in location A but eleven attended both training workshops. In location B, fourteen attended the first workshop, while twelve attended the second workshop. Participants who attended the training were administered pre-training and post-training surveys. The pre-training surveys included demographic information, professional experience, educational background and professional training, whereas the post-training survey involved questions about the impact and efficacy of the training delivered. The second stage involved conducting in-depth qualitative interviews with participants who attended the training workshops. The main goal was to evaluate the impact on professional practice and change in attitudes amongst PAs and PDTs. Data collected from the surveys and interviews were analysed using quantitative and qualitative content analysis via an inductive process. In addition, an interpretive phenomenological analysis was undertaken to identify and code themes emerging from the interviews. Ethics approval was received through the Federation University’s Human Research Ethics Committee before the commencement of this project

Transplantation of cells for cardiac repair

AbstractThe inability of adult cardiomyocytes to divide to a significant extent and regenerate the myocardium after injury leads to permanent deficits in the number of functional cells, which can contribute to the development and progression of heart failure. The transplantation of skeletal myoblasts or stem cells or cardiomyocytes derived from them into the injured myocardium is a novel and promising approach in the treatment of cardiac disease and the restoration of myocardial function. In this article, skeletal myoblasts and embryonic and bone marrow stem cells are discussed in the context of their potential therapeutic use in cardiac failure. The state of the art in both laboratory and clinic is presented. We discuss current and intrinsic limitations of cardiac cellular transplantation and suggest directions for future research

Correlates of pedometer use: Results from a community-based physical activity intervention trial (10,000 Steps Rockhampton)

Background: Pedometers have become common place in physical activity promotion, yet little information exists on who is using them. The multi-strategy, community-based 10,000 Steps Rockhampton physical activity intervention trial provided an opportunity to examine correlates of pedometer use at the population level. Methods: Pedometer use was promoted across all intervention strategies including: local media, pedometer loan schemes through general practice, other health professionals and libraries, direct mail posted to dog owners, walking trail signage, and workplace competitions. Data on pedometer use were collected during the 2-year follow-up telephone interviews from random population samples in Rockhampton, Australia, and a matched comparison community (Mackay). Logistic regression analyses were used to determine the independent influence of interpersonal characteristics and program exposure variables on pedometer use. Results: Data from 2478 participants indicated that 18.1% of Rockhampton and 5.6% of Mackay participants used a pedometer in the previous 18-months. Rockhampton pedometer users (n = 222) were more likely to be female (OR = 1.59, 95% CI: 1.11, 2.23), aged 45 or older (OR = 1.69, 95% CI: 1.16, 2.46) and to have higher levels of education (university degree OR = 4.23, 95% CI: 1.86, 9.6). Respondents with a BMI > 30 were more likely to report using a pedometer (OR = 1.68, 95% CI: 1.11, 2.54) than those in the healthy weight range. Compared with those in full-time paid work, respondents in 'home duties' were significantly less likely to report pedometer use (OR = 0.18, 95% CI: 0.06, 0.53). Exposure to individual program components, in particular seeing 10,000 Steps street signage and walking trails or visiting the website, was also significantly associated with greater pedometer use. Conclusion: Pedometer use varies between population subgroups, and alternate strategies need to be investigated to engage men, people with lower levels of education and those in full-time 'home duties', when using pedometers in community-based physical activity promotion initiatives

Organs-on-Chips in Drug Development: The Importance of Involving Stakeholders in Early Health Technology Assessment

Organs-on-chips are three-dimensional, microfluidic cell culture systems that simulate the function of tissues and organ subunits. Organ-on-chip systems are expected to contribute to drug candidate screening and the reduction of animal tests in preclinical drug development and may increase efficiency of these processes. To maximize the future impact of the technology on drug development, it is important to make informed decisions regarding the attributes and features of organs-on-chips even though the technology is still in a stage of early development. It is likely that different stakeholders in organ-on-chip development, such as engineers, biologists, regulatory scientists, and pharmaceutical researchers, will have different perspectives on how to maximize the future impact of the technology. Various aspects of organ-on-chip development, such as cost, materials, features, cell source, read-out technology, types of data, and compatibility with existing technology, will likely be judged differently by different stakeholders. Early health technology assessment (HTA) is needed in order to facilitate the essential integration of such potentially conflicting views in the process of technology development. In this critical review we discuss the potential impact of organs-on-chips on the drug development process, and we use a pilot study to give examples of how different stakeholders have different perspectives on attributes of organ-on-chip technology. As a future tool in early HTA of organs-on-chips, we suggest the use of multicriteria decision analysis (MCDA), which is a formal method to deal with multiple and conflicting criteria in technology development. We argue that it is essential to design and perform a comprehensive MCDA for organ-on-chip development, and so the future impact of this technology in the pharmaceutical industry can be maximized

Late time HST UV and optical observations of AT~2018cow: extracting a cow from its background

The bright, blue, rapidly evolving AT2018cow is a well-studied peculiar extragalactic transient. Despite an abundance of multi-wavelength data, there still is no consensus on the nature of the event. We present our analysis of three epochs of Hubble Space Telescope (HST) observations spanning the period from 713-1474 days post burst, paying particular attention to uncertainties of the transient photometry introduced by the complex background in which AT2018cow resides. Photometric measurements show evident fading in the UV and more subtle but significant fading in the optical. During the last HST observation, the transient's optical/UV colours were still bluer than those of the substantial population of compact, young, star-forming regions in the host of AT2018cow, suggesting some continued transient contribution to the light. However, a compact source underlying the transient would substantially modify the resulting spectral energy distribution, depending on its contribution in the various bands. In particular, in the optical filters, the complex, diffuse background poses a problem for precise photometry. An underlying cluster is expected for a supernova occurring within a young stellar environment or a tidal-disruption event (TDE) within a dense older one. While many recent works have focused on the supernova interpretation, we note the substantial similarity in UV light-curve morphology between AT2018cow and several tidal disruption events around supermassive black holes. Assuming AT2018cow arises from a TDE-like event, we fit the late-time emission with a disc model and find $M_{BH} = 10^{3.2{\pm}0.8}$ M$_{\odot}$. Further observations are necessary to determine the late-time evolution of the transient and its immediate environment.Comment: 16 pages, 10 figures. Accepted for publication in MNRA

Clinical effectiveness of a manual based coping strategy programme (START, STrAtegies for RelaTives) in promoting the mental health of carers of family members with dementia: pragmatic randomised controlled trial

Objective To assess whether a manual based coping strategy compared with treatment as usual reduces depression and anxiety symptoms in carers of family members with dementia. Design Randomised, parallel group, superiority trial. Setting Three mental health community services and one neurological outpatient dementia service in London and Essex, UK. Participants 260 carers of family members with dementia. Intervention A manual based coping intervention comprising eight sessions and delivered by supervised psychology graduates to carers of family members with dementia. The programme consisted of psychoeducation about dementia, carers’ stress, and where to get emotional support; understanding behaviours of the family member being cared for, and behavioural management techniques; changing unhelpful thoughts; promoting acceptance; assertive communication; relaxation; planning for the future; increasing pleasant activities; and maintaining skills learnt. Carers practised these techniques at home, using the manual and relaxation CDs. Main outcome measures Affective symptoms (hospital anxiety and depression total score) at four and eight months. Secondary outcomes were depression and anxiety caseness on the hospital anxiety and depression scale; quality of life of both the carer (health status questionnaire, mental health) and the recipient of care (quality of life-Alzheimer’s disease); and potentially abusive behaviour by the carer towards the recipient of care (modified conflict tactics scale). Results 260 carers were recruited; 173 were randomised to the intervention and 87 to treatment as usual. Mean total scores on the hospital anxiety and depression scale were lower in the intervention group than in the treatment as usual group over the eight month evaluation period: adjusted difference in means −1.80 points (95% confidence interval −3.29 to −0.31; P=0.02) and absolute difference in means −2.0 points. Carers in the intervention group were less likely to have case level depression (odds ratio 0.24, 95% confidence interval 0.07 to 0.76) and there was a non-significant trend towards reduced case level anxiety (0.30, 0.08 to 1.05). Carers’ quality of life was higher in the intervention group (difference in means 4.09, 95% confidence interval 0.34 to 7.83) but not for the recipient of care (difference in means 0.59, −0.72 to 1.89). Carers in the intervention group reported less abusive behaviour towards the recipient of care compared with those in the treatment as usual group (odds ratio 0.47, 95% confidence interval 0.18 to 1.23), although this was not significant. Conclusions A manual based coping strategy was effective in reducing affective symptoms and case level depression in carers of family members with dementia. The carers’ quality of life also improved. Trial registration Current Controlled Trials ISCTRN70017938