FGF23 metabolism, a new paradigm for chronic kidney disease

Introduction:  Fibroblast growth factor-23 (FGF23) is a major regulator of phosphate metabolism often elevated in genetic hypophosphataemic disorders and in chronic kidney disease. Recent studies have identified relationships between FGF23 and various markers of iron status including ferritin. New assays measuring the intact form of FGF23 have been released.  Objective:  To determine the relationship between ferritin and C-terminal and intact FGF23 concentrations in blood.  Method:  FGF23 concentrations were measured using the 2nd generation, two-site enzyme-linked immunosorbent assay for either C-terminal or intact FGF23 (Immutopics Inc., Ca, USA). Ferritin was measured on a COBAS 6000 (Roche Diagnostics). Assay accuracy and precision were monitored using kit controls supplied by the manufacturers.  Results:  We observe a weak negative correlation between measurements of C-terminal and intact FGF23 (Pearson’s rho=0.85 p<0.0001). We observed no statistically significant correlation of ferritin concentrations with either FGF23 C-terminal or intact. However high concentrations of ferritin were observed in samples showing low concentrations of C-terminal FGF23 (<140RU/mL) and intact FGF23 (<122pg/mL).  Conclusion:  Although not statistically significant, we observe a negative relationship between concentrations of ferritin and FGF23. High level of C-terminal FGF23 is found in patients with chronic kidney disease, especially in patients with end-stage renal disease usually regarded as a compensatory response to hyperphosphatemia or phosphate overload. We observed a cluster of patients with retention of both C-terminal and intact FGF23 associated with low levels of ferritin suggesting that metabolism and/or excretion of FGF23 in CDK patients might be an iron dependent mechanism

The psychological challenges of living with an ileostomy: an interpretative phenomenological analysis

Objectives: Ileostomy, in which the small intestine is re-directed out of an abdominal wall so that waste is collected using a bag, is used to treat conditions including Inflammatory Bowel Disease and colorectal cancer. This paper reports an in depth idiographic analysis of the experience of living with an ileostomy. Methods: 21 participants took part in semi-structured interviews about their lives and relationships. Those interviews were transcribed verbatim and analysed using the experiential qualitative methodology Interpretative Phenomenological Analysis (IPA). Results: Two super-ordinate themes arose from the data: Ileostomy’s intra-personal impact; the impact of ileostomy on relationships with others. We found that ileostomy may destabilise the sense of self, disrupt body image, and alter experience of age and sexuality. Other participants were able to employ their illness to positively reframe the self. Disclosure of ileostomy status was difficult for some. Intimate and friend relationships were often challenged by stoma status, whilst other family relationships were largely characterised as supportive. Conclusions: Ileostomy may impact upon both intra and interpersonal aspects of the lives of those who live with it, in both negative and positive ways. Consequently, the sense of self can appear challenged, and relationships with partners, family members and friendships could be causes of distress. On the other hand, some partners were supportive, and children were found to be sources of comfort

Are urban landscapes associated with reported life satisfaction and inequalities in life satisfaction at the city level? A cross-sectional study of 66 European cities

With more than half the world's population residing in urban areas and this proportion rising, it is important to understand how well-planned urban environments might improve, and reduce inequalities in, quality of life (QoL). Although studies suggest city-level characteristics hold independent influence on QoL, they generally lack a theoretically informed approach to understanding how the whole city landscape might be implicated, have paid scant attention to inequalities in QoL and often focus on small numbers of cities or countries. We applied theory and methods from landscape ecology to explore associations between cities' land cover/use, residents' reported life satisfaction and within-city socio-economic inequalities in life satisfaction. We joined individual-level responses to the European Urban Audit (EUA) Perception Surveys (2012, 2015) with city-level data from the European Urban Atlas classifying land cover/use into 26 different classes. Our sample included 63,554 people from 66 cities in 28 countries. Multilevel binary logistic models found that specific land use measures were associated with life satisfaction, including the amount of a city which was: residential (OR:0.991, 95%CI 0.984–0.997); isolated structures (OR:1.046, 95 CI 1.002–1.091); roads (OR:0.989, 95%CI 0.982–0.996); pastures (OR: 1.002, 95% CI 1.002–1.003) and herbaceous vegetation (OR:0.998, 95%CI 0.997–0.100). A more even distribution of land cover/use (β: 1.561, 95%CI -3.021 to −0.102) was associated with lower inequality in life satisfaction. This is the first study to theorise and examine how the entire urban landscape may affect levels of and inequalities in wellbeing in a large international sample. Our finding that more equal distribution of land cover/use is associated with lower levels of socio-economic inequality in life satisfaction supports the idea that city environments could be equigenic – that is, could create equality. Our findings can aid urban planners to develop and build cities that can contribute to improving, and narrowing inequalities in, residents' life satisfaction

Active commute to school: does distance from school or walkability of the home neighbourhood matter? A national cross-sectional study of children aged 10–11 years, Scotland, UK

Objectives: To study the extent to which home-to-school distance and neighbourhood walkability were associated with self-reported active travel to school (ATS) (eg, walking, cycling), and to explore how distance moderates the effect of walkability on ATS, among 10–11 years old. Design: Cross-sectional study. Setting: Data were collected between May 2015 and May 2016 in partnership with the Growing Up in Scotland Study, a nationally representative longitudinal cohort study. Participants: 713 children (male (n=330) and female (n=383) 10–11 years old) from Studying Physical Activity in Children’s Environments across Scotland. Primary and secondary outcome measures: Children who actively travelled to/from school categorised as active all (100% of ATS) and active 60%+ (at least 60% of ATS); home-to-school road/path network distance (&lt;0.5 km, 0.5 to &lt;1 km, 1 to &lt;1.5 km, 1.5 to &lt;2 km, 2 km+); home neighbourhood walkability (i.e., composite measure of road/path intersection density and dwelling density) (in quintiles). Results: Distance and walkability were both associated with ATS. The likelihood of ATS for all or most journeys decreased with increasing distance. Compared with ‘most’ walkable areas (Q1), the odds of active all were significantly lower within least walkable areas (Q5 OR 0.45, 95% CI 0.21 to 0.99), and odds of active 60%+ were significantly less in Q2–Q5 (lowest odds Q5 OR 0.20, 95% CI 0.07 to 0.47). Regarding walkability and distance interactions, for all distance categories, higher walkability increased the probability of ATS (for most school journeys). Conclusion: Walkability was positively associated with ATS within all distance categories, with the relationship between walkability and ATS more complex than the clear-cut association between distance and ATS. A more walkable environment had a larger effect on the probability of reaching the 60% threshold of school journeys using ATS than the probability of always travelling in an active manner. Investment is needed in existing less walkable neighbourhoods to provide infrastructure to support opportunities for children’s ATS

Keep that language going! A needs-based review of the status of indigenous languages in South Australia

A consultancy carried out by the Australian Institute of Aboriginal and Torres Strait Islander Studies for the Aboriginal and Torres Strait Islander Commission, South Australia.Patrick McConvell, Rob Amery, Mary-Anne Gale, Christine Nicholls, Jonathan Nicholls, Lester Irabinna Rigney and Simone Ulalka Tu

Convergent validity and reliability of a novel repeated agility protocol in junior rugby league players

Background: : Rugby league involves repeated, complex, and high intensity change-of-direction (COD) movements with no existing test protocols that specifically assesses these multiple physical fitness components simultaneously. Thus, the current study examined the convergent validity of a repeated Illinois Agility (RIA) protocol with the repeated T-agility protocol, and the repeatability of the RIA protocol in adolescent Rugby League players. Furthermore, aerobic capacity and anaerobic and COD performance were assessed to determine whether these physical qualities were important contributors to the RIA protocol. Methods: Twenty-two junior Rugby League players completed 4 sessions with each separated by 7 days. Initially, physical fitness characteristics at baseline (i.e., Multi-stage Shuttle test, countermovement jump, 30-m sprint, single-effort COD and repeated sprint ability [RSA]) were assessed. The second session involved a familiarisation of RIA and repeated T-agility test (RTT) protocols. During the third and fourth sessions, participants completed the RIA and RTT protocols in a randomised, counterbalanced design to examine the validity and test-retest reliability of these protocols. Results: For convergent validity, significant correlations were identified between RIA and RTT performances (r= >0.80; p0.71; p < 0.05). Reliability of the RIA protocol was near perfect with excellent intra-class correlation coefficient (0.87-0.97), good ratio limits of agreement (×/÷ 1.05-1.06) and low coefficient of variations (1.8-2.0%). Conclusions: The current study has demonstrated the RIA to be a simple, valid and reliable field test for RL athletes that can provide coaches with information about their team’s ability to sustain high intensity, multi-directional running efforts

Do neighbourhood characteristics matter in understanding school children’s active lifestyles? a cross-region multi-city comparison of Glasgow, Edinburgh and Hong Kong

Many studies have explored the influence of individual and neighbourhood factors on active school travel (AST), this novel study is the first to examine how AST and formal extracurricular activities are associated with children’s active lifestyles. The aims of this study were to (a) create an active lifestyle variable (ALIFE) measured in terms of total weekly minutes of AST and extracurricular activities, and (b) explore how ALIFE is associated with different attributes at the individual, household and neighbourhood levels, and how these relationships differ for children aged 10 and 11 years old across the three cities: Glasgow, Edinburgh and Hong Kong. We found environmental factors to be important indicators of lower AST, for example greater parking facility density. The most substantial contribution to children’s overall ALIFE was household income, those from the lowest household group having almost 2 h less ALIFE per-week than those from the highest income