Adherence, efficacy and patient perspective of a multi-disease, community-based exercise programme

Background: The growing burden of chronic disease (CD) in Ireland represents the greatest challenge to Irish Health Services. The role of physical activity/exercise training (PAET) is well established as an adjunct therapy in the management of CD. An integrated multi-disease, community-based exercise programme (MCEP) has the potential to offer a resource-efficient strategy to provide exercise in the community for either those with CD following completion of medically supervised hospital-based programmes or for individuals who do not require medical supervision. The purpose of this PhD was to assess the adherence to, efficacy of and patient perspective of a MCEP. A total of 118 patients with coronary artery disease (CAD) who had completed hospital-based cardiac rehabilitation, along with individuals with other CD (OCD), were referred by health care professionals to a newly established MCEP. CAD patients who could not attend the MCEP were assigned to a control group (CAD-CG) that received usual care advice. Study 1 evaluated baseline characteristics of individuals with CAD (96, 73%M) to those with OCD (98, 47%M) and a CAD-CG (22, 77%M) and compared rates and predictors of adherence to the MCEP. Outcome measures were socioeconomic and health-based demographics, health indices, functional capacity, and health-related quality of life (HRQoL). There was a significant difference in age, gender, number of comorbidities, and certain medications/conditions between the groups. Individuals with CAD had significantly better functional capacity and HRQoL scores than individuals with OCD. Females and individuals with lower mental wellbeing were less likely to attend and more likely to drop out. Study 2 evaluated the efficacy of participation in a MCEP for 10-weeks on selected health indices, functional capacity, and HRQoL. Lower body muscle strength increased (p < 0.005) in both CAD and OCD compared to CAD-CG. Within group improvements were found in aerobic fitness (p < 0.005) and waist circumference (p < 0.05) in both CAD and OCD, while upper body strength (p = 0.003) and perceived physical (p = 0.013) and mental health (p = 0.003) improved in OCD only. Study 3 explored CAD patient experiences of participation in a MCEP and dimensions influencing their physical activity engagement. Twenty-four individuals (63% M) who completed the initial 10 weeks of the MCEP attended a focus group, analysed using inductive thematic analysis. Main themes identified included ‘moving from fear to confidence’, ‘drivers of engagement’, ‘challenges to maintaining exercise adherence’ and ‘life beyond their illness’. Conclusion: An integrated MCEP was found to be a safe, effective, and acceptable setting for improving or maintaining actual and perceived physical, and mental, wellbeing in individuals with CD. Females and individuals with lower mental wellbeing should be supported to encourage adherence

‘The illness isn’t the end of the road’—Patient perspectives on the initiation of and early participation in a multi-disease, community-based exercise programme

Background: Exercise is the cornerstone of cardiac rehabilitation (CR). Hospital-based CR exercise programmes are a routine part of clinical care and are typically 6–12 weeks in duration. Following completion, physical activity levels of patients decline. Multi-disease, community-based exercise programmes (MCEP) are an efficient model that could play an important role in the long-term maintenance of positive health behaviours in individuals with cardiovascular disease (CVD) following their medically supervised programme. Aim: To explore patients experiences of the initiation and early participation in a MCEP programme and the dimensions that facilitate and hinder physical activity engagement. Methods: Individuals with established CVD who had completed hospital-based CR were referred to a MCEP. The programme consisted of twice weekly group exercise classes supervised by clinical exercise professionals. Those that completed (n = 31) an initial 10 weeks of the programme were invited to attend a focus group to discuss their experience. Focus groups were transcribed and analysed using reflexive thematic analysis. Results: Twenty-four (63% male, 65.5±6.12yrs) patients attended one of four focus groups. The main themes identified were ‘Moving from fear to confidence’, ‘Drivers of engagement,’ and ‘Challenges to keeping it (exercise) up’. Conclusion: Participation in a MCEP by individuals with CVD could be viewed as a double-edged sword. Whilst the programme clearly provided an important transition from the clinical to the community setting, there were signs it may breed dependency and not effectively promote independent exercise. Another novel finding was the use of social comparison that provided favourable valuations of performance and increased exercise confidence

Predicting and preventing relapse of depression in primary care

'No abstract

Widespread anticoagulant poison exposure is linked with immune dysregulation and severe notoedric mange in urban bobcats

peer reviewe

New metrics for the Lancet Standing Commission on Liver Disease in the UK

Health Polic

A gap analysis on modelling of sea lice infection pressure from salmonid farms. I. A structured knowledge review

Sustainability of aquaculture, an important component of the blue economy, relies in part on ensuring assessment of environmental impact and interactions relating to sea lice dispersing from open pen salmon and trout farms. We review research underpinning the key stages in the sea lice infection process to support modelling of lice on wild salmon in relation to those on farms. The review is split into 5 stages: larval production; larval transport and survival; exposure and infestation of new hosts; development and survival of the attached stages; and impact on host populations. This modular structure allows the existing published data to be reviewed and assessed to identify data gaps in modelling sea lice impacts in a systematic way. Model parameterisation and parameter variation is discussed for each stage, providing an overview of knowledge strength and gaps. We conclude that a combination of literature review, empirical data collection and modelling studies are required on an iterative basis to ensure best practice is applied for sustainable aquaculture. The knowledge gained can then be optimised and applied at regional scales, with the most suitable modelling frameworks applied for the system, given regional limitations

A gap analysis on modelling of sea lice infection pressure from salmonid farms. II. Identifying and ranking knowledge gaps: output of an international workshop

Sea lice are a major health hazard for farmed Atlantic salmon in Europe, and their impact is felt globally. Given the breadth of ongoing research in sea lice dispersal and population modelling, and focus on research-led adaptive management, we brought experts together to discuss research knowledge gaps. Gaps for salmon lice infection pressure from fish farms were identified and scored by experts in sea lice-aquaculture-environment interactions, at an international workshop in 2021. The contributors included experts based in Scotland, Norway, Ireland, Iceland, Canada, the Faroe Islands, England and Australia, employed by governments, industry, universities and non-government organisations. The workshop focused on knowledge gaps underpinning 5 key stages in salmon lice infection pressure from fish farms: larval production; larval transport and survival; exposure and infestation of new hosts; development and survival of the attached stages; and impact on host populations. A total of 47 research gaps were identified; 5 broad themes emerged with 13 priority research gaps highlighted as important across multiple sectors. The highest-ranking gap called for higher quality and frequency of on-farm lice count data, along with better sharing of information across sectors. We highlight the need for synergistic international collaboration to maximise transferable knowledge. Round table discussions through collaborative workshops provide an important forum for experts to discuss and agree research priorities

Vaccine hesitancy and reported non-vaccination in an Irish pediatric outpatient population

Vaccine hesitancy is defined as a delay in acceptance, or refusal, of vaccines, despite availability. It is a complex and context specific phenomenon and identified as a global health priority. The “Parent Attitudes about Childhood Vaccines” (PACV) questionnaire is a validated tool for identifying vaccine hesitancy. Our aim was to use the PACV to assess vaccine hesitancy and its relationship with reported non-vaccination in an Irish population, for the first time. Our participants were parents or caregivers of children attending general pediatric clinics in a tertiary pediatric hospital in Dublin, Ireland, between September and December 2018. In total, 436 participants completed the questionnaire. 5.5% of our population reported non-vaccination. Human papilloma virus and measles, mumps, rubella vaccines were the most commonly cited vaccines of concern (11.5% and 6.7%, respectively), and autism spectrum disorder was the most commonly side effect of concern (4.3%). Mean PACV score was 26.9 (SD 19.1), with a significant difference between non-vaccinators and vaccinators (53.2 vs 25.3, pConclusion: PACV identified reported non-vaccination with high accuracy in our population. It may be useful to screen vaccine-hesitant parents who could benefit from interventions to improve uptake.What is Known:• Vaccine hesitancy is a leading threat to global health, with falls in vaccine uptake associated with disease outbreaks worldwide.• The Parent Attitudes about Childhood Vaccines (PACV) questionnaire is a validated measure of vaccine hesitancy and correlates with non-vaccination in many populations.What is New:• This large study in a pediatric outpatient clinic setting represents the first use of the PACV in a Western European population to assess vaccination hesitancy.• The PACV may be an effective way of screening a pediatric clinic population to identify vaccine-hesitant parents or caregivers for targeted vaccine promotion.</div

Exposure of Wildlife to Anticoagulant Rodenticides at Santa Monica Mountains National Recreation Area: From Mountain Lions to Rodents

A 15-year study of carnivores in an urban landscape in southern California has revealed a high incidence of exposure of non-target wildlife to anticoagulant rodenticides (ARs). All carnivore species studied, including mountain lions, coyotes, bobcats, and gray foxes, have tested positive for exposure to the toxicants. Anticoagulant residues have been detected in post-mortem liver samples at a rate of 83-93% of individuals tested, for coyotes, bobcats, and mountain lions, the three species for which we have extensive sampling. We have also documented mortalities caused directly by exposure to ARs in all four species, particularly in the canids. In both felid species, we found a positive correlation between AR exposure and mange disease, specifically notoedric mange. The incidence of fatal mange infection in bobcats has been at epizootic levels since 2002 in our study area, and more recently outbreaks of the disease have been documented in several other populations in California, all apparently (where testing has been done) in association with exposure to ARs. There are no previously reported instances of epizootics of notoedric mange in any wild felid population. Carnivore exposure to these toxicants appears to be largely secondary (or tertiary, as may be the case in mountain lions) through consumption of their natural prey. In our most recent work, we have evaluated AR exposure of carnivore prey species, including rodents and lagomorphs. We have documented exposure in ground squirrels and woodrats, both of which are regularly consumed by gray foxes, coyotes, and bobcats. Overall, we have found widespread exposure of non-target wildlife to these toxicants, with potentially significant consequences for some species