Application of the COM-B model to barriers and facilitators to chlamydia testing in general practice for young people and primary care practitioners: a systematic review

Background Chlamydia is a major public health concern, with high economic and social costs. In 2016, there were over 200,000 chlamydia diagnoses made in England. The highest prevalence rates are found among young people. Although annual testing for sexually active young people is recommended, many do not receive testing. General practice is one ideal setting for testing, yet attempts to increase testing in this setting have been disappointing. The Capability, Opportunity, and Motivation Model of Behaviour (COM-B model) may help improve understanding of the underpinnings of chlamydia testing. The aim of this systematic review was to (1) identify barriers and facilitators to chlamydia testing for young people and primary care practitioners in general practice and (2) map facilitators and barriers onto the COM-B model. Methods Qualitative, quantitative, and mixed methods studies published after 2000 were included. Seven databases were searched to identify peer-reviewed publications which examined barriers and facilitators to chlamydia testing in general practice. The quality of included studies was assessed using the Critical Appraisal Skills Programme. Data (i.e., participant quotations, theme descriptions, and survey results) regarding study design and key findings were extracted. The data was first analysed using thematic analysis, following this, the resultant factors were mapped onto the COM-B model components. All findings are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Four hundred eleven papers were identified; 39 met the inclusion criteria. Barriers and facilitators were identified at the patient (e.g., knowledge), provider (e.g., time constraints), and service level (e.g., practice nurses). Factors were categorised into the subcomponents of the model: physical capability (e.g., practice nurse involvement), psychological capability (e.g.: lack of knowledge), reflective motivation (e.g., beliefs regarding perceived risk), automatic motivation (e.g., embarrassment and shame), physical opportunity (e.g., time constraints), social opportunity (e.g., stigma). Conclusions This systematic review provides a synthesis of the literature which acknowledges factors across multiple levels and components. The COM-B model provided the framework for understanding the complexity of chlamydia testing behaviour. While we cannot at this juncture state which component represents the most salient influence on chlamydia testing, across all three levels, multiple barriers and facilitators were identified relating psychological capability and physical and social opportunity. Implementation should focus on (1) normalisation, (2) communication, (3) infection-specific information, and (4) mode of testing. In order to increase chlamydia testing in general practice, a multifaceted theory- and evidence-based approach is needed

A critical evaluation of the usefulness of a coding scheme to categorise levels of reflective thinking

The use of reflective learning journals to encourage higher order learning outcomes is a growing area in higher education research and practice. However, without a unified and clear definition of reflection, identifying and assessing reflection is problematic for educators. In an attempt to address this issue Kember et al. (1999) devised a coding scheme based on the work of Mezirow (1991), to identify and assess levels of reflective thinking in students’ written journals. We evaluated the usefulness of this coding scheme in a business education context. Findings revealed that the scheme was useful in identifying categories of reflective thinking. Initial inter-coder agreement ranged from 50-79%. On average, 65% of the journal content was coded as non-reflection and 35% as reflection. A further outcome of the research was to refine the coding scheme and to provide suggestions for its application in teaching practice

Redox proteomic analysis of the gastrocnemius muscle from adult and old mice.

The data provides information in support of the research article, "Differential Cysteine Labeling and Global Label-Free Proteomics Reveals an Altered Metabolic State in Skeletal Muscle Aging", Journal of Proteome Research, 2014, 13 (11), 2008-21 [1]. Raw data is available from ProteomeXchange [2] with identifier PDX001054. The proteome of gastrocnemius muscle from adult and old mice was analyzed by global label-free proteomics and the relative quantification of specific reduced and reversibly oxidized Cysteine (Cys) residues was performed using Skyline [3]. Briefly, reduced Cysteine (Cys) containing peptides was alkylated using N-ethylmalemide (d0-NEM). Samples were desalted and reversibly oxidized Cys residues were reduced using tris(2-carboxyethyl)phosphine (TCEP) and the newly formed reduced Cys residues were labeled with heavy NEM( d5-NEM). Label-free analysis of the global proteome of adult (n=5) and old (n=4) gastrocnemius muscles was performed using Peaks7™ mass spectrometry data analysis software [4]. Relative quantification of Cys containing peptides that were identified as reduced (d(0) NEM labeled) and reversibly oxidized d(5)-NEM labeled was performed using the intensity of their precursor ions in Skyline. Results indicate that muscles from old mice show reduced redox flexibility particularly in proteins involved in the generation of precursor metabolites and energy metabolism, indicating a loss in the flexibility of the redox energy response

Facilitators and barriers to chlamydia testing in general practice for young people using a theoretical model (COM-B): a systematic review protocol

Introduction Chlamydia is a key health concern with high economic and social costs. There were over 200 000 chlamydia diagnoses made in England in 2015. The burden of chlamydia is greatest among young people where the highest prevalence rates are found. Annual testing for sexually active young people is recommended; however, many of those at risk do not receive testing. General practice has been identified as an ideal setting for testing, yet efforts to increase testing in this setting have not been effective. One theoretical model which may provide insight into the underpinnings of chlamydia testing is the Capability, Opportunity and Motivation Model of Behaviour (COM-B model). The aim of this systematic review is to: (1) identify barriers and facilitators to chlamydia testing for young people in general practice and (2) use a theoretical model to conduct a behavioural analysis of chlamydia testing behaviour. Methods and analysis Qualitative, quantitative and mixed methods studies published after 2000 will be included. Seven databases (MEDLINE, PubMed, EMBASE, Informit, PsycInfo, Scopus, Web of Science) will be searched to identify peer-reviewed publications which examined barriers and facilitators to chlamydia testing in general practice. Risk of bias will be assessed using the Critical Appraisal Skills Programme. Data regarding study design and key findings will be extracted. The data will be analysed using thematic analysis and the resultant factors will be mapped onto the COM-B model components. All findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ethics and dissemination Ethical approval is not required. The results will be disseminated via submission for publication to a peer-review journal when complete and for presentation at national and international conferences. The review findings will be used to inform the development of interventions to facilitate effective and efficient chlamydia testing in general practice

Risk factors for feline infectious peritonitis in Australian cats

Objective: To determine whether patient signalment (age, breed, sex, and neuter status) are associated with naturally occurring feline infectious peritonitis (FIP) in cats in Australia. Design: A retrospective comparison of the signalment between cats with confirmed FIP and the general cat population. Results: The patient signalment of 382 FIP confirmed cases were compared with the Companion Animal Register of NSW and the general cat population of Sydney. Younger cats were significantly over-represented amongst FIP cases. Domestic crossbred, Persian, and Himalayan cats were significantly under-represented in the FIP cohort while several breeds were over-represented including British Shorthair, Devon Rex, and Abyssinian. A significantly higher proportion of male cats had FIP compared to female cats. Conclusion: This study provides further evidence that FIP is primarily a disease of young cats and that significant breed and sex predilections exist in Australia. This opens further avenues to investigate the role of genetic factors in FIP

Risk factors for feline infectious peritonitis in Australian cats

Objective: To determine whether patient signalment (age, breed, sex, and neuter status) are associated with naturally occurring feline infectious peritonitis (FIP) in cats in Australia. Design: A retrospective comparison of the signalment between cats with confirmed FIP and the general cat population. Results: The patient signalment of 382 FIP confirmed cases were compared with the Companion Animal Register of NSW and the general cat population of Sydney. Younger cats were significantly over-represented amongst FIP cases. Domestic crossbred, Persian, and Himalayan cats were significantly under-represented in the FIP cohort while several breeds were over-represented including British Shorthair, Devon Rex, and Abyssinian. A significantly higher proportion of male cats had FIP compared to female cats. Conclusion: This study provides further evidence that FIP is primarily a disease of young cats and that significant breed and sex predilections exist in Australia. This opens further avenues to investigate the role of genetic factors in FIP

Redox Regulation in Health and Disease Application of redox proteomics to skeletal muscle aging and exercise

Abstract Skeletal muscle represents a physiologically relevant model for the application of redox proteomic techniques to dissect its response to exercise and aging. Contracting skeletal muscles generate ROS (reactive oxygen species) and RNS (reactive nitrogen species) necessary for the regulation of many proteins involved in excitation-contraction coupling. The magnitude and species of ROS/RNS generated by contracting muscles will have downstream effects on specific protein targets and cellular redox signalling. Redox modifications on specific proteins are essential for the adaptive response to exercise and skeletal muscle can develop a dysregulated redox response during aging. In the present article, we discuss how redox proteomics can be applied to identify and quantify the reversible modifications on susceptible cysteine residues within those redox-sensitive proteins, and the integration of oxidative and non-oxidative protein modifications in relation to the functional proteome. Skeletal muscle as a redox model Skeletal muscle represents the largest organ of the human body and comprises approximately 40 % of total body mass in humans. Over the age of 50, there is a decline in skeletal muscle mass in adults. The decline in muscle mass and associated function is referred to as sarcopenia, and can lead to a reduction in the ability to perform daily tasks and loss of independence amongst the elderly Key words: aging, cysteine modification, exercise, redox proteomics, signalling, skeletal muscle. Abbreviations: eNOS, endothelial NOS; ICAT, isotope-coded affinity tag; iTRAQ, isobaric tag for relative and absolute quantification; MRM, multiple reaction monitoring; NOS, nitric oxide synthase; PTM, post-translational modification; RNS, reactive nitrogen species; ROS, reactive oxygen species. 1 To whom correspondence should be addressed (email [email protected]). A number of questions remain as to the source of the signals required for the generation of ROS and RNS, the identification of their specific protein targets (and modifications) and how the redox signals are relayed throughout the muscle fibre. The intensity of muscle contractions, muscle fibre type, and the fitness and the age of the individual may all have an effect on both the levels and type of ROS/RNS generated. Aging muscle has an altered redox response with subsequent physiological and biochemical effects on the cytoskeleton, mitochondria, Ca 2 + signalling and sequestration. Exercise is known to induce the generation of ROS and RNS that results in the activation of a number of transcription factors, including NF-κB (nuclear factor κB), AP-1 (activator protein 1) and HSF-1 (heat-shock factor 1), and induces mitochondrial biogenesis (for a review, see Defining the biochemical pathways and processes within skeletal muscles that are affected by ROS/RNS and how these responses change with age and exercise could help our understanding of biological aging. Moderate levels of ROS/RNS generally act through a reversible thiol-disulfideexchange mechanism on specific cysteine residues and can modify key target proteins by altering both the structur

Single-base substitutions in the CHM promoter as a cause of choroideremia

Although over 150 unique mutations affecting the coding sequence of CHM have been identified in patients with the X-linked chorioretinal disease choroideremia (CHM), no regulatory mutations have been reported, and indeed the promoter has not been defined. Here, we describe two independent families affected by CHM bearing a mutation outside the gene's coding region at position c.-98: C>A and C>T, which segregated with the disease. The male proband of family 1 was found to lack CHM mRNA and its gene product Rab escort protein 1, whereas whole-genome sequencing of an affected male in family 2 excluded the involvement of any other known retinal genes. Both mutations abrogated luciferase activity when inserted into a reporter construct, and by further employing the luciferase reporter system to assay sequences 5′ to the gene, we identified the CHM promoter as the region encompassing nucleotides c.-119 to c.-76. These findings suggest that the CHM promoter region should be examined in patients with CHM who lack coding sequence mutations, and reveals, for the first time, features of the gene's regulation

Hospital service use in the last year of life by Indigenous Australians who died of heart failure or cardiomyopathy : a linked data study

Background: Aboriginal and Torres Strait Islander peoples experience disproportionate rates of heart failure. However, information regarding their use of hospital services in the last year of life is poorly delineated to inform culturally appropriate end-of-life health services. Objectives: To quantify hospital service use in the last year of life of Aboriginal and Torres Strait Islander peoples who died of heart failure or cardiomyopathy in Queensland, Australia. Methods: A subgroup analysis of a larger retrospective linkage study using administrative health data in Queensland, Australia. Individuals that identified as an Aboriginal and Torres Strait Islander person from their first hospital admission in the last year of life, who died of heart failure or cardiomyopathy from 2008 to 2018, were included. Results: There were 99 individuals, with emergency department presentation/s recorded for 85 individuals. Over 50% of individuals presenting to the Emergency Department were from regional areas (n = 43, 51%). The 99 individuals had a total of 472 hospital admissions, excluding same day admissions for haemodialysis, and 70% (n = 70) died in hospital. Most admissions were coded as acute care (n = 442, 94%), and fewer were coded as palliative care (n = 19, 4%). Median comorbidities or factors that led to hospital contact = 5 (interquartile range 3–9). Conclusion: Acute care hospital admissions in the last year of life by this population are common for those who died of heart failure or cardiomyopathy. Multimorbidity is prevalent in the last year of life, underscoring the importance of primary health care, provided by nurses and Indigenous health workers