Uptake to a community based chronic illness rehabilitation programme (CBCIR): Is there a gender disparity?

Background: Multi-morbidity and chronic conditions pose a threat to population health. Despite known benefits of rehabilitation using structured exercise, uptake to such programmes remain sub-optimal. The aim of this study is to identify the psychosocial and health related fitness correlates of uptake to a CBCIR in men and women, with the secondary aim of identifying the rate of uptake. Methods: Participants referred to a CBCIR via GPs and hospitals completed an induction process. This introduced them to the CBCIR programme and got them to complete a multi-section questionnaire (including instruments on physical activity, exercise self-efficacy, intentions for exercise, and perceived family/friend social support) and complete a battery of physical health measures (including the Incremental shuttle walk test (ISWT), a lower body strength test and body mass index (BMI)). Post induction participants who attended an exercise class were classified as ‘Uptakers’, whilst those who never came back were classified as ‘Non-Uptakers’. Class attendance was objectively monitored by the researchers. Data were analysed using SPSS, and are presented using means, standard deviations and proportions, group differences are examined via t-tests and logistic regression was used to predict uptake. Results: A total of 441 participants (56% male; average age 64.3 ±12 years completed induction measures. Overall, 77% were identified as Uptakers (81% female, 74% male, p=0.068, 2-sided). Among men, Uptakers reported more days of 30mins moderate to vigorous physical activity (t(111) = -2.499,

A between sex analysis of self and proxy efficacy and its relationship with attendance at a community based chronic illness rehabilitation programme.

Background: Physical activity is a principal intervention in primary and secondary prevention of chronic illness. While the benefits of community based rehabilitation is acknowledged,the rate of attendance and adherence remains sub optimal. Self-efficacy is acknowledged to be a key factor relating to adherence in rehabilitation but the construct of proxy efficacy, defined as one’s confidence in the skills and abilities of a third party to function effectively on another’s behalf, is less often studied. This paper examines the relationship between gender and ‘self’ and ‘proxy-efficacy’ and their potential role in attendance to a community based chronic illness rehabiliation (CBCIR) programme. Methods: Participants attending induction at the programme completed a questionnaire assessing demographics and both self (9 items) and proxy efficacy for exercise (9 items) which was assessed on a Likert scale from 0 (not confident at all) to 10 (very confident), with a higher score indicating greater efficacy. Subsequently, attendance was objectively monitored by researchers at exercise sessions for 24 weeks. Results: 69 participants (M age=65.5 +9.8 years, 56% Male) completed all measures. Mean proxy-efficacy and mean self-efficacy is significantly greater in women compared to men (p<0.05). Mean proxy-efficacy was found to be higher than mean self-efficacy in both males (proxy-efficacy=8.7+1.2, self efficacy=8.3+1.8) and females (proxyefficacy= 7.7+2.2, self-efficacy=6.5+2.0) with no correlation between the variables. Correlational analyses found a moderate significant positive correlation between proxy efficacy and number of weeks attended in the 24 weeks (r=.440,p<.05) in women with no correlation observed between self-efficacy and weeks attended. No correlations are observed between either form of efficacy and attendance in men. Discussion: Participants report greater confidence in the proxy agent than themselves as the agent. This was furthered in women with an association identified between proxy efficacy and 24-week attendance. These results suggest the importance of the proxy for women in a CBCIR setting but further longitudinal research should be carried out in the area of proxy efficacy and attendance at community based chronic illness rehabilitation programmes. Implications: An understanding of these variables help CBCIR programme facilitators intervene to ensure greater attendance

RandomiSed clinical trial assessing Use of an anti-inflammatoRy aGent in attenUating peri-operatiVe inflAmmatioN in non-meTastatic colon cancer – the S.U.R.G.U.V.A.N.T. trial

Background: Peri-operative inflammation has been extensively highlighted in cancer patients as detrimental. Treatment strategies to improve survival for cancer patients through targeting peri-operative inflammation have yet to be devised. Methods: We conducted a multi-centre, randomised controlled clinical trial using Taurolidine in non-metastatic colon cancer patients. Patients were randomly assigned to receive Taurolidine or a placebo. The primary endpoint for the study was the mean difference in day 1 IL-6 levels. Secondary clinical endpoints included rates of post-operative infections and tumor recurrence. Results: A total of 293 patients were screened for trial inclusion. Sixty patients were randomised. Twenty-eight patients were randomised to placebo and 32 patients to Taurolidine. IL-6 levels were equivalent on day 1 post-operatively in both groups. However, IL-6 levels were significantly attenuated over the 7 day study period in the Taurolidine group compared to placebo (p = 0.04). In addition, IL-6 levels were significantly lower at day 7 in the Taurolidine group (p = 0.04). There were 2 recurrences in the placebo group at 2 years and 1 in the Taurolidine group. The median time to recurrence was 19 months in the Placebo group and 38 months in the Taurolidine group (p = 0.27). Surgical site infection was reduced in the Taurolidine treated group (p = 0.09). Conclusion: Peri-operative use of Taurolidine significantly attenuated circulating IL-6 levels in the initial 7 day post-operative period in a safe manner. Future studies are required to establish the impact of IL-6 attenuation on survival outcomes in colon cancer. Trial registration: The trial was registered with EudraCT (year = 2008, registration number = 005570–12) and ISRCTN (year = 2008, registration number = 77,829,558)

Body composition, inflammation, and 5-year outcomes in colon cancer

Importance: Obesity, particularly visceral obesity and sarcopenia, are poor prognostic indicators in colon cancer. Objectives: To explore the association between body composition profiles and 5-year colon cancer outcomes and delineate the associated underlying inflammatory processes. Design, Setting, and Participants: This multicenter translational cohort study included patients with nonmetastatic colon cancer who did not have underlying chronic inflammatory disorders and were not receiving anti-inflammatory drugs referred to tertiary cancer centers from 2009 to 2015. Preoperative acute phase proteins (white cell count, C-reactive protein, and albumin), cytokines (interleukin [IL]-1b, IL-2, IL-6, IL-10, interferon γ, and tumor necrosis factor α), vascular endothelial growth factor (VEGF), and cell surface receptor expression levels (CD11b and CD14) were measured. All patients underwent follow-up for at least 5 years. Data were analyzed in December 2020. Exposure: Nonmetastatic colon cancer. Main Outcomes and Measures: The associations of body composition profiles with 5-year cancer recurrence and disease-specific mortality were analyzed using Mantel Cox log-rank test and Kaplan-Meier curves. Results: A total of 28 patients were included (median [interquartile range] age, 67 [58-72] years; 22 [78.6%] men). Low skeletal muscle area (SMA) and high visceral to total fat ratio were associated with poor clinical and oncological outcomes, including increased 5-year recurrence (low SMA: hazard ratio [HR], 2.30 [95% CI, 1.41-2.89]; P = .04; high visceral to total fat ratio: HR, 5.78 [95% CI, 3.66-7.95]; P = .02). High visceral to total fat ratio was associated with increased 5-year disease-specific mortality (HR, 5.92 [95% CI, 4.04-8.00]; P = .02). Patients with low SMA who developed a cancer recurrence, compared with those who did not, had higher C-reactive protein (mean [SD], 31.24 [6.95] mg/dL vs 8.11 [0.58] mg/dL; P = .003), IL-6 (mean [SD], 1.93 [1.16] ng/mL vs 0.88 [0.14] ng/mL; P = .004), VEGF (mean [SD], 310.03 [122.66] ng/mL vs 176.12 [22.94] ng/mL; P = .007), and CD14 (mean [SD], 521.23 [302.02] ng/mL vs 322.07 [98.35] ng/mL; P = .03) expression and lower albumin (mean [SD], 3.8 [0.6] g/dL vs 43.50 [3.69] g/dL; P = .01), IL-2 (mean [SD], 0.45 [0.25] ng/mL vs 0.94 [0.43] ng/mL; P < .001), IL-10 (mean [SD], 8.15 [1.09] ng/mL vs 16.32 [4.43] ng/mL; P = .004), and interferon γ (mean [SD], 2.61 [1.36] ng/mL vs 14.87 [3.43] ng/mL; P = .02) levels. Patients with high visceral to total fat ratio who developed recurrence had higher levels of IL-6 (mean [SD], 5.26 [7.05] ng/mL vs 2.76 [3.11] ng/mL; P = .03) and tumor necrosis factor α (mean [SD], 5.74 [4.53] ng/mL vs 4.50 [1.99] ng/mL; P = .03). Conclusions and Relevance: These findings suggest that low SMA and high visceral to total fat ratio were associated with worse colon cancer outcomes and with increased expression of proinflammatory cytokines and VEGF and inhibition of anti-inflammatory cytokines

Examination of adherence to a community based chronic illness exercise programme and the development and feasibility evaluation of a multi-component intervention

Background Community-based multi-chronic illness exercise programmes provide a resource efficient way to assist with the treatment/management of chronic illness. Despite the well-documented benefits of participation in community-based chronic illness exercise programmes (CCEP), adherence remains sub-optimal with positive effects of such programmes relying on optimal adherence. Difficulty remains in interpreting rates of adherence and correlates due to programme heterogeneity. Given the health benefits to be gained from regular attendance, empirically based interventions and strategies to optimise adherence are warranted. The purpose of this thesis was to i) identify rates of initiation, attendance and retention and to identify factors associated with adherence to a CCEP and ii) design, implement and evaluate the feasibility of an intervention aimed at optimising adherence. Methods Individuals with chronic illness were referred to a CCEP by health professionals. Study 1 (n=381) was a prospective study encompassing cross-sectional and prospective analysis designs to identify the rates and correlates of adherence. Primary statistical analysis included independent samples t-tests, bivariate correlations, logistic regression and negative binomial regression. An intervention based on Study 1 and the existing evidence base was designed and developed using the behaviour change wheel. Study 2 (n=295) was a feasibility study of a behaviour change intervention aimed at optimising adherence rates (composed of intervention at baseline, week-4 and 12). Study 2 also utilised a quasi-experimental research design to compare trends in rates of adherence over 24 weeks between those receiving the intervention and those not. xvii Results Study 1: The initiation rate was 73% and the mean number of sessions attended in the 24-weeks was 11. Bivariate analysis identified intentions, self-efficacy and BMI as correlates of initiation. Following adjusted analysis, the associations were no longer statistically significant. Further bivariate analysis indicated chronic illness group, distance to facility, intentions, self-efficacy for exercise and attendance in the first 4 weeks as correlates of 24-week attendance. In an adjusted analysis, age and distance to facility were the only as predictors of attendance. The first 4 weeks’ attendance when added to the previous models was the only independent predictor of 24-week attendance. Study 2: A theoretically informed behaviour change intervention was designed utilising the behaviour change wheel. The intervention was evaluated in terms of its feasibility, and with only 25.6% of participants attending all component of the intervention as planned it is deemed not feasible in its current form. The intervention was also evaluated using intention to treat and per-protocol analysis and using an intention to treat analysis trends indicate that retention was greater in the Intervention than the Standard group. There was no difference in initiation or attendance between the Intervention and Standard group. Per-protocol analysis found trends toward improvements in initiation (96% vs 73.2%,), attendance (mean SD) (22.22 ±12.59 vs 11.13±12.42) and retention (56.3% vs 28.7%) in the Intervention compared to the Standard group. Conclusion: Bivariate correlates of adherence to a CCEP are diverse, with early stage attendance the strongest predictor of 24-week attendance. The inclusion of a xviii theoretically informed behaviour change intervention can improve adherence in those who attend all components of the intervention, however, the intervention did not prove feasible. Further research should identify correlates of adherence to CCEP to inform the design and implementation of interventions to optimise physical and mental health in men and women with chronic illness

A national survey to map IPE in Ireland

Interprofessional education (IPE) in Ireland is at an early stage. Currently, there is no data to reflect the amount and type of IPE occurring across the Island of Ireland. To support IPE implementation, data is needed on existing IPE which will identify gaps and foundations on which to build. We designed a cross sectional, online, anonymous survey to map geographical IPE locations, IPE setting, and type of IPE offered. Results were analyzed by exporting raw data to Microsoft Excel. The survey was completed by 21 participants. Over half of participants (n = 12) came from two professions: physiotherapy and speech and language therapy. Participants were from 4 counties (from a potential 32): Cork, Dublin, Galway, and Limerick. There were twice as many university educator participants (n = 14) as compared to clinical educators (n = 7). Shared modules and guest lectures from other professions were frequent methods of shared learning. At university level the most frequent IPE activity was interprofessional problem-based learning/case study. At clinical sites students interact with a range of qualified professionals and have limited opportunities to work with students from other professions. This may impact the range of collaborative work skills developed and thus readiness for workforce entry

On a problem of bases for the regular extension of varieties of algebras

SIGLECopy held by FIZ Karlsruhe; available from UB/TIB Hannover / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Absence of evidence or evidence of absence - a review of the evidence for hydroxychloroquine as a potential candidate for prophylaxis against COVID-19

Clinical trials are investigating several agents as potential options for pre-exposure prophylaxis and post-exposure prophylaxis to prevent infection with COVID-19. A particular focus has been high risk groups including healthcare workers. Chloroquine (CQ) and hydroxychloroquine (HCQ) are the predominant agents in terms of numbers of clinical trials listed on Clinicaltrials.gov. However, CQ/HCQ have not been proven as an effective treatment option for COVID-19, and it is currently unclear what benefit, if any, is available to support their use in a prophylactic role. Four randomised control trials have been published so far which have examined the effect of HCQ as pre-exposure (PrEP) and post-exposure prophylaxis (PEP). This study summarises the evidence to date for HCQ as a potential prophylactic option for PEP and PrEP, presents both the aggregated and disaggregated data and details the gaps in the evidence base. The absolute risk differences for the pre-exposure prophylaxis studies were -0.3% to -2% and for the post prophylaxis studies were -0.6% and -2.4%. There were more adverse events noted in the hydroxychloroquine arms across all four studie