The UPDATE trial (UVBPhototherapy in Dermatology for ATopic Eczema):study protocol for a randomized controlled trial of narrowband UVB with optimal topical therapy versus optimal topical therapy in patients with atopic eczema

Background: Narrowband ultraviolet B (NB-UVB) phototherapy is commonly prescribed for patients with moderate-to-severe atopic eczema (AE). The efficacy of NB-UVB, however, has not yet properly been established, as current evidence is of low certainty. Our aim is to assess the short-term and long-term (cost-)effectiveness and safety of NB-UVB in adult AE patients by performing a pragmatic, multicenter, prospective, randomized, open-label, blinded-endpoint (PROBE) trial. This protocol outlines its methodology. Methods: A pragmatic, multicenter, PROBE trial will be performed with 1:1 randomization of 316 adult patients with moderate-to-severe AE who have inadequate disease control with topical therapy and who are eligible for optimal topical therapy (OTT) or NB-UVB in combination with OTT as a next step. Participants in the interventional arm will receive a minimum of 3 months of OTT combined with 8 to 16 weeks of NB-UVB. The control group receives 3 months of OTT. Following the interventional phase, follow-up will continue for 9 months. Physician-reported and patient-reported outcomes (according to the Harmonising Outcome Measures for Eczema (HOME) Core Outcome Set) and adverse events are assessed at 4 weeks, 3, 6, 9, and 12 months. Discussion: The UPDATE trial aims to provide high-quality evidence regarding the (cost-)effectiveness and safety of NB-UVB phototherapy in moderate-to-severe AE patients. Challenges that are addressed in the protocol include the possible bias arising from applying open-label treatment and the necessity of introducing OTT into the study design to prevent a high dropout rate.Trial registration: ClinicalTrials.gov NCT05704205. Registered on December 8, 2022.</p

Effectiveness of dupilumab treatment in 95 patients with atopic dermatitis: daily practice data

Background: Dupilumab is the first biologic registered for the treatment of moderate-to-severe atopic dermatitis (AD), and efficacy was shown in phase III clinical trials (primary outcome at week 16 was reached in 38% of patients). Currently, there are limited daily practice data available for dupilumab, especially when it is combined with systemic immunosuppressants. Objectives: To evaluate dupilumab treatment in daily practice in patients with AD. Methods: In this observational cohort study, we prospectively included all adult patients with AD who had been treated with dupilumab in two university hospitals in the Netherlands. Concomitant systemic immunosuppressive treatment was monitored. Physician-reported outcome measures and patient-reported outcome measures (PROMs) after ≥ 12 we

Attendance behavior of ex-members in fitness clubs: A retrospective study applying the stages of change

The transtheoretical model of behavior change (TTM) is often used to understand and predict health-related behavior. The objective of this study is to apply the TTM’s stages of change to examine patterns of attendance behavior at fitness clubs. A retrospective study was performed to study the later stages of change, using attendance data of members who cancelled their membership in 2012 in two European fitness chains, including 259,355 ex-members of 267 clubs. A sample of 400 was selected at random for analyses, M age = 32.1 yr. (SD = 10.9; 64% males) and 34.7 yr. (SD = 11.0; 51% males) for BasicFit and HealthCity. Regular attendance behavior was defined by at least four visits per month. In the past, all ex-members had purchased a membership and by that were considered to have entered the preparation stage, but 19.5% had never attended the club in 24 months. Of the ex-members, 10% demonstrated regular attendance behavior for six months, and 2.3% had regular attendance for 24 months. 49% did not attend the club for one full month but started regular attendance again. Significant positive correlations were found in attendance behavior between the 6th and 12th months (r = .61), and the 12th and 24th months (r = .45), suggesting that ex-members who attended for more than six months were more likely to have maintained their attendance behavior. With only 10% of the members demonstrating regular attendance behavior, it is evident that appropriate strategies have to be developed to improve attendance behavior and facilitate exercise behavior in fitness clubs

The effects of a self-efficacy intervention on exercise behavior of fitness club members in 52 weeks and long-term relationships of transtheoretical model constructs

The transtheoretical model of behavior change (TTM) is often used to understand changes in health-related behavior, like exercise. Exercise behavior in fitness clubs is an understudied topic, but preliminary studies showed low frequencies and large numbers of drop-out. An initial 12-week self-efficacy intervention reported significant effects on exercise behavior. The objective of this follow up study is testing effects on exercise behavior over 52 weeks and the long-term relationships of all TTM constructs. In total 122 participants (Mage 42.02 yr.; SD 12.29; 67% females) were recruited and randomly assigned to group 1 (control), group 2 (self-set activities) and group 3 (self-set goals coaching). All participants were monitored 52-weeks. Measurements at baseline, 4, 8, 12, 26 and 52 weeks, using validated scales for stages of change, self-efficacy, decisional balance and processes of change. Exercise behavior and drop-outs were registered. An ANOVA revealed that group 3 significantly (p < 0.05) differed in exercise sessions from group 1 and 2 during the 12 weeks. A chi-square test indicated significant differences for continuing exercising after the intervention: 7 of group 1; 6 of group 2; 19 of group 3. In total 5 demonstrated regular exercise behavior at 26 weeks, and 3 at 52 weeks. Self-efficacy, decisional balance, and processes of change showed limited long-term changes over the later stages of change. At all measurements, participants reported more pros than cons and used more behavioral than cognitive processes. Exercise behavior of members in fitness clubs demonstrated dramatic developments in 52 weeks. The frequencies of sessions were so low that health effects will be minimal. The integrative character of the TTM appears to be weak; the data indicated limited relationships. More research is needed to understand exercise behavior and define optimal strategies to increase exercise attendance and decrease drop-outs in the long term

Expression der mRNA von Lysyl Oxidase und Lysyl Oxidase Like 2 in Plattenepithelkarzinomen des oberen Aerodigestivtraktes

Die Menge an Lysyl Oxidase (LOX)- und Lysyl Oxidase Like 2 (LOXL2)-mRNA in Zelllinien und Gewebebiopsien aus Plattenepithelkarzinomen des oberen Aerodigestivtraktes (HNSCC) wurde mittels Reverse Transkriptase Polymerase-Kettenreaktion (RT-PCR) untersucht. Die mRNA-Level von LOX in HNSCC-Zellen und -Geweben zeigten sich im Vergleich zu normalen Kontrollen reduziert. Weiterhin war eine Verminderung von LOXL2-mRNA in Karzinom-Zellen nachweisbar. In den untersuchten HNSCC-Gewebeproben hingegen war die Menge an LOXL2-mRNA kaum geringer als in den entsprechenden normalen Referenzproben. Die erzielten Ergebnisse unterstützen daher den schon in früheren Studien vermuteten tumorsuppressiven Charakter von LOX und LOXL2. Damit wird eine mögliche Tumorsuppressor-Funktion oder auch eine „Anti-Tumor-Funktion“ von LOX und LOXL2 zum ersten Mal auch bei HNSCC-Tumoren aufgezeigt. Eine Invasivitäts-fördernde Funktion von LOX und LOXL2 konnte für HNSCC nicht gezeigt werden. LOX und LOXL2 könnten mögliche Kandidatengene darstellen, deren jeweiliger Expressionsgrad bzw. spezifische Expressionsmuster eventuell auch in Kombination mit dem Expressionsmuster anderer LOXLs von diagnostischer, prognostischer oder auch therapeutischer Bedeutung für Patienten mit HNSCC-Tumoren sein könnten. Beide Gene, LOX und LOXL2, sollten als potentielle Tumorsuppressor-Gene oder zumindest als Komponenten eines tumorsuppressiven Stoffwechselweges bei HNSCC-Tumoren angesehen werden und könnten möglicherweise als Angriffspunkt für neue molekulartherapeutische Konzepte dienen

The Effects of a Self-Efficacy Intervention on Exercise Behavior of Fitness Club Members in 52 Weeks and Long-Term Relationships of Transtheoretical Model Constructs

The transtheoretical model of behavior change (TTM) is often used to understand changes in health-related behavior, like exercise. Exercise behavior in fitness clubs is an understudied topic, but preliminary studies showed low frequencies and large numbers of drop-out. An initial 12-week self-efficacy intervention reported significant effects on exercise behavior. The objective of this follow up study is testing effects on exercise behavior over 52 weeks and the long-term relationships of all TTM constructs. In total 122 participants (Mage 42.02 yr.; SD 12.29; 67% females) were recruited and randomly assigned to group 1 (control), group 2 (self-set activities) and group 3 (self-set goals coaching). All participants were monitored 52-weeks. Measurements at baseline, 4, 8, 12, 26 and 52 weeks, using validated scales for stages of change, self-efficacy, decisional balance and processes of change. Exercise behavior and drop-outs were registered. An ANOVA revealed that group 3 significantly (p < 0.05) differed in exercise sessions from group 1 and 2 during the 12 weeks. A chi-square test indicated significant differences for continuing exercising after the intervention: 7 of group 1; 6 of group 2; 19 of group 3. In total 5 demonstrated regular exercise behavior at 26 weeks, and 3 at 52 weeks. Self-efficacy, decisional balance, and processes of change showed limited long-term changes over the later stages of change. At all measurements, participants reported more pros than cons and used more behavioral than cognitive processes. Exercise behavior of members in fitness clubs demonstrated dramatic developments in 52 weeks. The frequencies of sessions were so low that health effects will be minimal. The integrative character of the TTM appears to be weak; the data indicated limited relationships. More research is needed to understand exercise behavior and define optimal strategies to increase exercise attendance and decrease drop-outs in the long term

The Effects of Two Self-Regulation Interventions to Increase Self-Efficacy and Group Exercise Behavior in Fitness Clubs

Studies on the adoption and maintenance of group exercise behavior are scarce. The objective of this study is to test two self-efficacy based interventions to increase barrier self-efficacy and group exercise behavior. In total 122 participants (Mage 42.02 yr.; SD 12.29; 67% females) were recruited and randomly assigned to one control and two experimental groups. The control group was limited to participate in one virtual group exercise program only (group 1). The first experimental group was able to self-set their activities and participate in multiple group exercise programs (group 2). The second experimental group received an additional monthly coaching protocol to manage self-set goals (group 3). A validated scale for barrier self-efficacy was used, group exercise sessions were measured and drop-out rates were registered. An ANOVA indicated that mean amount of sessions of group 1 and 3, and 2 and 3 differed significantly (p < 0.05) in 12 weeks. Descriptive statistics demonstrate mean group exercise sessions over the total of 12 weeks of 2.74 (SD 4.65) in the control group; 4.75 (SD 6.08) in the first experimental group, and 12.25 (SD 9.07) for the second experimental group. Regression analysis indicated that self-efficacy at 8-weeks explained the highest variance in overall group exercise sessions (R2 = 0.18; p < 0.05). Overall drop-out rates were 88% in group 1, 78% in group 2 and 48% in group 3. The results showed that group exercise behavior can significantly be improved by a coaching protocol on self-set goals. Future research should address the effectiveness of self-set activities and self-set goals for a longer period of time and in other types of exercise programs