University College London: Leveraging the Civic Capacity of ‘London’s Global University\u27

TesisChiclayoEscuela de PosgradoEvaluación y aprendizajeEl objetivo del presente estudio fue determinar el grado de relación entre la procrastinación académica y adaptación a la vida universitaria en estudiantes del primer ciclo de las escuelas de educación inicial y comunicación de la Universidad Católica Santo Toribio de Mogrovejo de Chiclayo, 2019, basándose en un enfoque cuantitativo, donde participaron 94 estudiantes ingresantes de las carreras de educación inicial y comunicación de la facultad de humanidades; para ello se utilizaron las escalas de Procrastinación Académica de Solomon & Rothblum, 1984 y el Cuestionario de Vivencias universitarias -QVA-r de Almeida & Ferreira - 1999. El análisis segmentado confirma la relación negativa y altamente significativa de procrastinación con adaptación a la vida universitaria. Con respecto a los niveles de procrastinación académica, resultó una predominancia del nivel medio seguida de un ligero dominio del nivel alto, en el caso de adaptación a la vida universitaria, se ha obtenido, un mayor dominio del nivel medio de adaptación, representado por el 45.8%; seguido del 29.2% que indica nivel alto; y el 25% que han desarrollado un nivel bajo. En suma, se obtuvo niveles medios en ambas dimensiones 44,8% y 47,9% respectivamente en Procrastinación académica mientras que, para la adaptación todas sus dimensiones han resultado con niveles medios

Improving uptake of Fracture Prevention drug treatments: a protocol for Development of a consultation intervention (iFraP-D).

Funder: Wellcome TrustINTRODUCTION: Prevention of fragility fractures, a source of significant economic and personal burden, is hindered by poor uptake of fracture prevention medicines. Enhancing communication of scientific evidence and elicitation of patient medication-related beliefs has the potential to increase patient commitment to treatment. The Improving uptake of Fracture Prevention drug treatments (iFraP) programme aims to develop and evaluate a theoretically informed, complex intervention consisting of a computerised web-based decision support tool, training package and information resources, to facilitate informed decision-making about fracture prevention treatment, with a long-term aim of improving informed treatment adherence. This protocol focuses on the iFraP Development (iFraP-D) work. METHODS AND ANALYSIS: The approach to iFraP-D is informed by the Medical Research Council complex intervention development and evaluation framework and the three-step implementation of change model. The context for the study is UK fracture liaison services (FLS), which enact secondary fracture prevention. An evidence synthesis of clinical guidelines and Delphi exercise will be conducted to identify content for the intervention. Focus groups with patients, FLS clinicians and general practitioners and a usual care survey will facilitate understanding of current practice, and investigate barriers and facilitators to change. Design of the iFraP intervention will be informed by decision aid development standards and theories of implementation, behaviour change, acceptability and medicines adherence. The principles of co-design will underpin all elements of the study through a dedicated iFraP community of practice including key stakeholders and patient advisory groups. In-practice testing of the prototype intervention will inform revisions ready for further testing in a subsequent pilot and feasibility randomised trial. ETHICS AND DISSEMINATION: Ethical approval was obtained from North West-Greater Manchester West Research Ethics Committee (19/NW/0559). Dissemination and knowledge mobilisation will be facilitated through national bodies and networks, publications and presentations. TRIAL REGISTRATION NUMBER: researchregistry5041

Rheumatic Conditions as Risk Factors for Self-Harm: A Retrospective Cohort Study

Objective To examine the risk of self-harm in rheumatological conditions Methods Retrospective cohort study using data from the Clinical Practice Research Datalink. Patients with ankylosing spondylitis, fibromyalgia, osteoarthritis or rheumatoid arthritis were identified between 1990–2016 and matched to patients without these conditions. Incident self-harm was defined by medical record codes following a rheumatological diagnosis. Incidence rates (per 10,000 person-years(PY)) were reported for each condition, both overall and year-on-year(2000-2016). Cox regression analysis determined risk (hazard ratios(HR), 95% confidence interval(CI)) of self-harm for each rheumatological cohort compared to the matched unexposed cohort. Initial crude analysis was subsequently adjusted and stratified by age and gender. Due to non-proportionality over time, osteoarthritis was also stratified by disease duration(<1 year, =1-<5 years, =5-<10 years, =10 years). Results Incidence of self-harm was highest in patients with fibromyalgia (25.12 (95%CI 22.45,28.11) per 10,000 PY) and lowest for osteoarthritis (6.48 (6.20, 6.76)). There was a crude association with each rheumatological condition and self-harm, except for ankylosing spondylitis. Though attenuated, these associations remained after adjustment for fibromyalgia (HR 2.06(95%CI 1.60,2.65)), rheumatoid arthritis (1.59(1.20,2.11)) and osteoarthritis (1-<5years: 1.12 (1.01,1.24); =5-<10 years: 1.35 (1.18,1.54)). Age and gender were weak effect modifiers for these associations. Conclusions Primary care patients with fibromyalgia, osteoarthritis or rheumatoid arthritis (but not ankylosing spondylitis) are at increased risk of self-harm compared to people without these rheumatological conditions. Clinicians need to be aware of the potential for self-harm in patients with rheumatological conditions (particularly fibromyalgia), explore mood and risk with them, and offer appropriate support and management

Activity compensation and activity synergy in British 8-13 year olds

Objectives. To examine whether children compensate for participating in physically active behaviors by reducing activity at other times (the 'activitystat' hypothesis); or alternatively become more active at other times (activity synergy).Methods. In 2002-2006, 345 British children (8-13 years) completed activity diaries and wore accelerometers. This generated 1077 days of data which we analyzed between-children (comparing all days) and within-child (comparing days from the same child).Results. On week and weekend days, each extra 1% of time in PE/games, school breaks, school active travel, non-school active travel, structured sports and out-of-home play predicted a 0.21 to 0.60% increase in the proportion of the day in moderate-to-vigorous physical activity (MVPA). None of these behaviors showed evidence of reduced MVPA at other times, i.e. activity compensation (all p>0.15). Moreover, each 1% increase in weekday non-school active travel predicted 0.38% more time in MVPA at other times (95% CI 0.18, 0.58). This activity synergy reflected children using active travel for playing and visiting friends.Conclusions. Contrary to the 'activitystat' hypothesis, we found no evidence of activity compensation. This suggests that interventions increasing activity in specific behaviors may increase activity overall. The activity synergy of non-school active travel underlines the need for further research into this neglected behavior

Improving uptake of Fracture Prevention drug treatments: a protocol for Development of a consultation intervention (iFraP-D)

Introduction Prevention of fragility fractures, a source of significant economic and personal burden, is hindered by poor uptake of fracture prevention medicines. Enhancing communication of scientific evidence and elicitation of patient medication-related beliefs has the potential to increase patient commitment to treatment. The Improving uptake of Fracture Prevention drug treatments (iFraP) programme aims to develop and evaluate a theoretically informed, complex intervention consisting of a computerised web-based decision support tool, training package and information resources, to facilitate informed decision-making about fracture prevention treatment, with a long-term aim of improving informed treatment adherence. This protocol focuses on the iFraP Development (iFraP-D) work. Methods and analysis The approach to iFraP-D is informed by the Medical Research Council complex intervention development and evaluation framework and the three-step implementation of change model. The context for the study is UK fracture liaison services (FLS), which enact secondary fracture prevention. An evidence synthesis of clinical guidelines and Delphi exercise will be conducted to identify content for the intervention. Focus groups with patients, FLS clinicians and general practitioners and a usual care survey will facilitate understanding of current practice, and investigate barriers and facilitators to change. Design of the iFraP intervention will be informed by decision aid development standards and theories of implementation, behaviour change, acceptability and medicines adherence. The principles of co-design will underpin all elements of the study through a dedicated iFraP community of practice including key stakeholders and patient advisory groups. In-practice testing of the prototype intervention will inform revisions ready for further testing in a subsequent pilot and feasibility randomised trial

Clinical Utility of Random Anti–Tumor Necrosis Factor Drug–Level Testing and Measurement of Antidrug Antibodies on the Long-Term Treatment Response in Rheumatoid Arthritis

Objective: To investigate whether antidrug antibodies and/or drug non-trough levels predict the long-term treatment response in a large cohort of patients with rheumatoid arthritis (RA) treated with adalimumab or etanercept and to identify factors influencing antidrug antibody and drug levels to optimize future treatment decisions.  Methods: A total of 331 patients from an observational prospective cohort were selected (160 patients treated with adalimumab and 171 treated with etanercept). Antidrug antibody levels were measured by radioimmunoassay, and drug levels were measured by enzyme-linked immunosorbent assay in 835 serial serum samples obtained 3, 6, and 12 months after initiation of therapy. The association between antidrug antibodies and drug non-trough levels and the treatment response (change in the Disease Activity Score in 28 joints) was evaluated.  Results: Among patients who completed 12 months of followup, antidrug antibodies were detected in 24.8% of those receiving adalimumab (31 of 125) and in none of those receiving etanercept. At 3 months, antidrug antibody formation and low adalimumab levels were significant predictors of no response according to the European League Against Rheumatism (EULAR) criteria at 12 months (area under the receiver operating characteristic curve 0.71 [95% confidence interval (95% CI) 0.57, 0.85]). Antidrug antibody–positive patients received lower median dosages of methotrexate compared with antidrug antibody–negative patients (15 mg/week versus 20 mg/week; P = 0.01) and had a longer disease duration (14.0 versus 7.7 years; P = 0.03). The adalimumab level was the best predictor of change in the DAS28 at 12 months, after adjustment for confounders (regression coefficient 0.060 [95% CI 0.015, 0.10], P = 0.009). Etanercept levels were associated with the EULAR response at 12 months (regression coefficient 0.088 [95% CI 0.019, 0.16], P = 0.012); however, this difference was not significant after adjustment. A body mass index of ≥30 kg/m2 and poor adherence were associated with lower drug levels.  Conclusion: Pharmacologic testing in anti–tumor necrosis factor–treated patients is clinically useful even in the absence of trough levels. At 3 months, antidrug antibodies and low adalimumab levels are significant predictors of no response according to the EULAR criteria at 12 months

Day length and weather effects on children's physical activity and participation in play, sports, and active travel.

BACKGROUND: Children in primary school are more physically active in the spring/summer. Little is known about the relative contributions of day length and weather, however, or about the underlying behavioral mediators. METHODS: 325 British children aged 8 to 11 wore accelerometers as an objective measure of physical activity, measured in terms of mean activity counts. Children simultaneously completed diaries in which we identified episodes of out-of-home play, structured sports, and active travel. Our main exposure measures were day length, temperature, rainfall, cloud cover, and wind speed. RESULTS: Overall physical activity was higher on long days (≥ 14 hours daylight), but there was no difference between short (< 9.5 hours) and medium days (10.2-12.6 hours). The effect of long day length was largest between 5 PM and 8 PM, and persisted after adjusting for rainfall, cloud cover, and wind. Up to half this effect was explained by a greater duration and intensity of out-of-home play on long days; structured sports and active travel were less affected by day length. CONCLUSIONS: At least above a certain threshold, longer afternoon/evening daylight may have a causal role in increasing child physical activity. This strengthens the public health arguments for daylight saving measures such as those recently under consideration in Britain

A methodology for evaluating walking buses as an instrument of urban transport policy

Walking buses are a relatively new phenomenon to encourage children to use an alternative to the car to travel to school. They consist of a group of children walking in a line along a set route, escorted by adults, and stopping to collect children at specific stops. There have been few systematic evaluations of their effectiveness as policy instruments. This paper describes a methodological framework to evaluate walking buses that is being developed as part of a larger project on children's car use. The paper uses preliminary data from five schools to demonstrate the types of outcome that can be considered within the framework.