A review of the prevalence of physical activity in health professional undergraduate, postgraduate, pre qualification courses and Continuous Professional Development activities

'Let's Make Scotland More Active' was published in 2003 by the then Scottish Executive and sets out the recommendations for increasing levels of physical activity (PA) within the population. One of the key strategy recommendations was that all patients coming into contact with primary care professionals should be offered screening and appropriate counselling for PA tailored to individual needs (paragraph 142). NHS Health Scotland has a range of existing and planned learning products and services aimed at influencing knowledge, attitudes and behaviour in the area of physical activity among the practitioner and wider health improvement workforces. These resources and services seek to encourage health professionals to increasingly deliver PA brief advice as an intervention in the care of their patients. However, it is not clear whether they are being used, or indeed the extent to which physical activity and its benefits are being taught to health professionals during undergraduate, post graduate and CPD training

Equine obesity: current perspectives

Foreword Equine obesity is now so common that is has become accepted by many as the norm ( Owers and Chubbock, 2012 ). Rates of obesity may be as high as 70% in some populations and obesity is often associated with morbidities that may ultimately result in mortality. Obesity is a common feature in animals diagnosed with equine metabolic syndrome, a conflation of metabolic disturbances including insulin dysregulation, which may lead to laminitis. Obesity is a risk factor for insulin dysregulation and is therefore implicated in laminitis risk. In addition to laminitis, adverse consequences of obesity include orthopaedic disease, hyperlipaemia, hyperthermia, infertility and poor performance. Over time, perception of what constitutes a healthy body condition in horses has shifted, with the result that potentially harmful excess adiposity may not be recognised by owners or those working in the equine industry ( Owers and Chubbock, 2012 ). In addition, increasing numbers of equines are kept as companions rather than athletes and live relatively inactive lifestyles favouring the development of obesity. Finally, owners of leisure horses often think their horses are working hard when, in reality, their exertions have minimal impact on their energy requirements. Despite increasing awareness within the veterinary profession and equine industry of the impact of obesity on equine welfare, little progress seems to have been made in tackling it. This document was commissioned in order to provide veterinary surgeons with up-to-date information on equine obesity and to equip them to tackle it within their own practices. Recommendations were developed using an informal two-round Delphi process, considering published and unpublished research relating to equine obesity using a round table forum and online discussion. Where research evidence was conflicting or absent, collective expert opinion based on the clinical experience of the group was applied. The opinions expressed are the consensus of views expressed by the authors. Where agreement was not reached, opposing views are presented such that readers can understand the arguments fully. The document is focused on the management of horses and ponies; while much of the information herein is applicable to donkeys it is important to recognise that the metabolism and management of donkeys are different and further research is required before specific recommendations can be made. The expert group was organised by UK-Vet Equine with sponsorship from Baileys Horse Feeds. </jats:sec

Asthma Exacerbations are Associated with a decline in Lung Function : A Longitudinal Population-Based Study

Funding This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was partially funded by Optimum Patient Care Global and AstraZeneca Ltd. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution. Acknowledgements The authors thank the UK primary care sites that contributed anonymised patient data to this study; Drs Jaco Voorham and Marjan Kerkhof for their contributions to the preparation and analysis of the data; and Audrey Ang and Andrea Teh Xin Yi for coordinating logistical and administrative support for the development of this manuscript. We also thank our Thorax peer reviewers for their in-depth comments and suggestions which greatly improved the quality of this article.Peer reviewedPostprin

Human gestation-associated tissues express functional cytosolic nucleic acid sensing pattern recognition receptors

The role of viral infections in adverse pregnancy outcomes has gained interest in recent years. Innate immune pattern recognition receptors (PRRs) and their signalling pathways, that yield a cytokine output in response to pathogenic stimuli, have been postulated to link infection at the maternal–fetal interface and adverse pregnancy outcomes. The objective of this study was to investigate the expression and functional response of nucleic acid ligand responsive Toll-like receptors (TLR-3, −7, −8 and −9), and retinoic acid-inducible gene 1 (RIG-I)-like receptors [RIG-I, melanoma differentiation-associated protein 5 (MDA5) and Laboratory of Genetics and Physiology 2(LGP2)] in human term gestation-associated tissues (placenta, choriodecidua and amnion) using an explant model. Immunohistochemistry revealed that these PRRs were expressed by the term placenta, choriodecidua and amnion. A statistically significant increase in interleukin (IL)-6 and/or IL-8 production in response to specific agonists for TLR-3 (Poly(I:C); low and high molecular weight), TLR-7 (imiquimod), TLR-8 (ssRNA40) and RIG-I/MDA5 (Poly(I:C)LyoVec) was observed; there was no response to a TLR-9 (ODN21798) agonist. A hierarchical clustering approach was used to compare the response of each tissue type to the ligands studied and revealed that the placenta and choriodecidua generate a more similar IL-8 response, while the choriodecidua and amnion generate a more similar IL-6 response to nucleic acid ligands. These findings demonstrate that responsiveness via TLR-3, TLR-7, TLR-8 and RIG-1/MDA5 is a broad feature of human term gestation-associated tissues with differential responses by tissue that might underpin adverse obstetric outcomes

Testosterone in advance age: a New Zealand longitudinal cohort study: life and living in advanced age (te puāwaitanga o ngā tapuwae kia ora tonu)

OBJECTIVES: Serum testosterone (T) levels in men decline with age. Low T levels are associated with sarcopenia and frailty in men aged &gt;80 years. T levels have not previously been directly associated with disability in older men. We explored associations between T levels, frailty and disability in a cohort of octogenarian men. SETTING: Data from all men from Life and Living in Advanced Age Cohort Study in New Zealand, a longitudinal cohort study in community-dwelling older adults. PARTICIPANTS: Community-dwelling (&gt;80 years) adult men excluding those receiving T treatment or with prostatic carcinoma. OUTCOMES MEASURES: Associations between baseline total testosterone (TT) and calculated free testosterone (fT), frailty (Fried scale) and disability (Nottingham Extended Activities of Daily Living scale (NEADL)) (baseline and 24&thinsp;months) were examined using multivariate regression and Wald\u27s &chi;2 techniques. Subjects with the lowest quartile of baseline TT and fT values were compared with those in the upper three quartiles. RESULTS: Participants: 243 men, mean (SD) age 83.7 (2.0) years. Mean (SD) TT=17.6 (6.8) nmol/L and fT=225.3 (85.4) pmol/L. On multivariate analyses, lower TT levels were associated with frailty: &beta;=0.41, p=0.017, coefficient of determination (R2)=0.10&thinsp;and disability (NEADL) (&beta;=-1.27, p=0.017, R2=0.11), low haemoglobin (&beta;=-7.38, p=0.0016, R2=0.05), high fasting glucose (&beta;=0.38, p=0.038, R2=0.04) and high C reactive protein (CRP) (&beta;=3.57, p=0.01, R2=0.06). Low fT levels were associated with frailty (&beta;=0.39, p=0.024, R2=0.09) but not baseline NEADL (&beta;=-1.29, p=0.09, R2=0.09). Low fT was associated with low haemoglobin (&beta;=-7.83, p=0.0008, R2=0.05) and high CRP (&beta;=2.86, p=0.04, R2=0.05). Relationships between baseline TT and fT, and 24-month outcomes of disability and frailty were not significant. CONCLUSIONS: In men over 80 years, we confirm an association between T levels and baseline frailty scores. The new finding of association between T levels and disability is potentially relevant to debates on T supplementation in older men, though, as associations were not present at 24 months, further work is needed

Cluster analysis of inflammatory biomarker expression in the International Severe Asthma Registry (ISAR)

Funding: ISAR is conducted by Optimum Patient Care Global Ltd, and co-funded by OPC Global Ltd and AstraZeneca.Peer reviewedPublisher PD

Potential severe asthma hidden in UK primary care

Funding: ISAR is conducted by Observational & Pragmatic Research Institution (OPRI), and co-funded by OPC Global and AstraZeneca. This research study was co-funded by AstraZeneca and Optimum Patient Care Global Limited, including access to the Optimum Patient Care Research Database (OPCRD).Peer reviewedPublisher PD

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis.

Global tuberculosis incidence has declined marginally over the past decade, and tuberculosis remains out of control in several parts of the world including Africa and Asia. Although tuberculosis control has been effective in some regions of the world, these gains are threatened by the increasing burden of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis. XDR tuberculosis has evolved in several tuberculosis-endemic countries to drug-incurable or programmatically incurable tuberculosis (totally drug-resistant tuberculosis). This poses several challenges similar to those encountered in the pre-chemotherapy era, including the inability to cure tuberculosis, high mortality, and the need for alternative methods to prevent disease transmission. This phenomenon mirrors the worldwide increase in antimicrobial resistance and the emergence of other MDR pathogens, such as malaria, HIV, and Gram-negative bacteria. MDR and XDR tuberculosis are associated with high morbidity and substantial mortality, are a threat to health-care workers, prohibitively expensive to treat, and are therefore a serious public health problem. In this Commission, we examine several aspects of drug-resistant tuberculosis. The traditional view that acquired resistance to antituberculous drugs is driven by poor compliance and programmatic failure is now being questioned, and several lines of evidence suggest that alternative mechanisms-including pharmacokinetic variability, induction of efflux pumps that transport the drug out of cells, and suboptimal drug penetration into tuberculosis lesions-are likely crucial to the pathogenesis of drug-resistant tuberculosis. These factors have implications for the design of new interventions, drug delivery and dosing mechanisms, and public health policy. We discuss epidemiology and transmission dynamics, including new insights into the fundamental biology of transmission, and we review the utility of newer diagnostic tools, including molecular tests and next-generation whole-genome sequencing, and their potential for clinical effectiveness. Relevant research priorities are highlighted, including optimal medical and surgical management, the role of newer and repurposed drugs (including bedaquiline, delamanid, and linezolid), pharmacokinetic and pharmacodynamic considerations, preventive strategies (such as prophylaxis in MDR and XDR contacts), palliative and patient-orientated care aspects, and medicolegal and ethical issues

The full value of vaccine assessments concept - current opportunities and recommendations

For vaccine development and adoption decisions, the ‘Full Value of Vaccine Assessment’ (FVVA) framework has been proposed by the WHO to expand the range of evidence available to support the prioritization of candidate vaccines for investment and eventual uptake by low- and middle-income countries. Recent applications of the FVVA framework have already shown benefits. Building on the success of these applications, we see important new opportunities to maximize the future utility of FVVAs to country and global stakeholders and provide a proof-of-concept for analyses in other areas of disease control and prevention. These opportunities include the following: (1) FVVA producers should aim to create evidence that explicitly meets the needs of multiple key FVVA consumers, (2) the WHO and other key stakeholders should develop standardized methodologies for FVVAs, as well as guidance for how different stakeholders can explicitly reflect their values within the FVVA framework, and (3) the WHO should convene experts to further develop and prioritize the research agenda for outcomes and benefits relevant to the FVVA and elucidate methodological approaches and opportunities for standardization not only for less well-established benefits, but also for any relevant research gaps. We encourage FVVA stakeholders to engage with these opportunities

Effectiveness of initiating biologics in severe asthma patients with high steroid exposure

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