How much do health care providers value a community-based asthma care program? – a survey to collect their opinions on the utilities of and barriers to its uptake

<p>Abstract</p> <p>Background</p> <p>A comprehensive asthma care program (ACP) based on Canadian Asthma Consensus Guidelines was implemented in 8 primary care sites in Ontario, Canada. A survey was distributed to health care providers' (HCPs) to collect their opinions on the utilities of and barriers to the uptake of the ACP.</p> <p>Methods</p> <p>A 39-item self-administered survey was mailed to 184 HCPs and support staff involved in delivering the ACP at the end of implementation. The items were presented in mixed formats with most items requiring responses on a five-point Likert scale. Distributions of responses were analyzed and compared across types of HCPs and sites.</p> <p>Results</p> <p>Of the 184 surveys distributed, 108 (59%) were returned, and of that, 83 were completed by HCPs who had clinical contact with the patients. Overall, 95% of the HCPs considered the ACP useful for improving asthma care management. Most HCPs favored using the asthma care map (72%), believed it decreased uncertainties and variations in patient management (91%), and considered it a convenient and reliable source of information (86%). The most commonly reported barrier was time required to complete the asthma care map. Over half of the HCPs reported challenges to using spirometry, while almost 40% identified barriers to using the asthma action plan.</p> <p>Conclusion</p> <p>Contrary to the notion that physicians believe that guidelines foster cookbook medicine, our study showed that HCPs believed that the ACP offered an effective and reliable approach for enhancing asthma care and management in primary care.</p

Impaired Growth and Force Production in Skeletal Muscles of Young Partially Pancreatectomized Rats: A Model of Adolescent Type 1 Diabetic Myopathy?

This present study investigated the temporal effects of type 1 diabetes mellitus (T1DM) on adolescent skeletal muscle growth, morphology and contractile properties using a 90% partial pancreatecomy (Px) model of the disease. Four week-old male Sprague-Dawley rats were randomly assigned to Px (n = 25) or Sham (n = 24) surgery groups and euthanized at 4 or 8 weeks following an in situ assessment of muscle force production. Compared to Shams, Px were hyperglycemic (>15 mM) and displayed attenuated body mass gains by days 2 and 4, respectively (both P<0.05). Absolute maximal force production of the gastrocnemius plantaris soleus complex (GPS) was 30% and 50% lower in Px vs. Shams at 4 and 8 weeks, respectively (P<0.01). GP mass was 35% lower in Px vs Shams at 4 weeks (1.24±0.06 g vs. 1.93±0.03 g, P<0.05) and 45% lower at 8 weeks (1.57±0.12 vs. 2.80±0.06, P<0.05). GP fiber area was 15–20% lower in Px vs. Shams at 4 weeks in all fiber types. At 8 weeks, GP type I and II fiber areas were ∼25% and 40% less, respectively, in Px vs. Shams (group by fiber type interactions, P<0.05). Phosphorylation states of 4E-BP1 and S6K1 following leucine gavage increased 2.0- and 3.5-fold, respectively, in Shams but not in Px. Px rats also had impaired rates of muscle protein synthesis in the basal state and in response to gavage. Taken together, these data indicate that exposure of growing skeletal muscle to uncontrolled T1DM significantly impairs muscle growth and function largely as a result of impaired protein synthesis in type II fibers

Current influences and approaches to promote future physical activity in 11–13 year olds: a focus group study

BACKGROUND: Many children and adolescents are failing to meet current physical activity (PA) guidelines and consequently not achieving the benefits associated with regular participation in PA, with girls consistently less active than boys. In order to design interventions to increase physical activity in adolescents it is important to understand their perceptions of and preferences for physical activity. METHODS: One hundred eighty participants, mean (SD) age 12.1 (0.5) years, completed the Physical Activity Questionnaire for Children (PAQ-C) and had height and weight measured. This information was used to select a subsample of participants (n64; mean (SD) age 12.3 (0.4) years; 39 females; 25 males; 25 % overweight/obese) to take part in focus group discussions. Participants were grouped based on PAQ-C responses into ‘low-active’ and ‘highly-active’ groups, so that those with similar existing levels of PA were in the same focus group. A semi-structured discussion guide was employed to explore the key influences on current PA participation and to actively seek ideas on how best to promote future PA in this population. In total, nine focus groups (mixed-gender) were conducted within the school setting. All focus groups were audio recorded, transcribed verbatim and analysed thematically. RESULTS: A number of themes emerged in relation to influences on current PA including friendship and peers, family and other people, the consequences of not taking part in PA, changing priorities, and cost and access to resources. With regards to the future provision of PA, participants favoured opportunities to try new activities, increased provision of school-based activities which can be undertaken with friends and activities which incorporated the use of technology and encouragement through rewards and incentives. Gender differences were apparent in relation to the types of activities participants preferred taking part in. Differences were also observed between ‘low-active’ and ‘highly-active’ groups in relation to barriers to current participation in PA. CONCLUSIONS: This study has highlighted a number of influences on current and future participation in PA, which differed based on gender and existing PA levels, for example, maximising the potential of the school day and including technology and incentives. These components can inform targeted interventions to increase PA in low active adolescents

Reversal of childhood idiopathic scoliosis in an adult, without surgery: a case report and literature review

<p>Abstract</p> <p>Background</p> <p>Some patients with mild or moderate thoracic scoliosis (Cobb angle <50-60 degrees) suffer disproportionate impairment of pulmonary function associated with deformities in the sagittal plane and reduced flexibility of the spine and chest cage. Long-term improvement in the clinical signs and symptoms of childhood onset scoliosis in an adult, without surgical intervention, has not been documented previously.</p> <p>Case presentation</p> <p>A diagnosis of thoracic scoliosis (Cobb angle 45 degrees) with pectus excavatum and thoracic hypokyphosis in a female patient (DOB 9/17/52) was made in June 1964. Immediate spinal fusion was strongly recommended, but the patient elected a daily home exercise program taught during a 6-week period of training by a physical therapist. This regime was carried out through 1992, with daily aerobic exercise added in 1974. The Cobb angle of the primary thoracic curvature remained unchanged. Ongoing clinical symptoms included dyspnea at rest and recurrent respiratory infections. A period of multimodal treatment with clinical monitoring and treatment by an osteopathic physician was initiated when the patient was 40 years old. This included deep tissue massage (1992-1996); outpatient psychological therapy (1992-1993); a daily home exercise program focused on mobilization of the chest wall (1992-2005); and manipulative medicine (1994-1995, 1999-2000). Progressive improvement in chest wall excursion, increased thoracic kyphosis, and resolution of long-standing respiratory symptoms occurred concomitant with a >10 degree decrease in Cobb angle magnitude of the primary thoracic curvature.</p> <p>Conclusion</p> <p>This report documents improved chest wall function and resolution of respiratory symptoms in response to nonsurgical approaches in an adult female, diagnosed at age eleven years with idiopathic scoliosis.</p

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth

<p>Abstract</p> <p>Background</p> <p>The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS).</p> <p>Methods</p> <p>All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting.</p> <p>Results</p> <p>The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D.</p> <p>Conclusion</p> <p>These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.</p

Views and experiences of behaviour change techniques to encourage walking to work: a qualitative study

BACKGROUND: High levels of physical inactivity are linked to several chronic diseases including coronary heart disease, type-2 diabetes, obesity, some cancers and poor mental health. Encouraging people to be more active has proven difficult. One way to incorporate physical activity into the daily routine is through the journey to and from work. Although behaviour change techniques (BCTs) are considered valuable in promoting behaviour change, there is very little in the published literature about the views and experiences of those encouraged to use them. METHODS: The Walk to Work study was a feasibility study incorporating an exploratory cluster randomised controlled trial. The 10-week intervention involved training workplace-based Walk to Work promoters (volunteers or nominated by participating employers) to encourage colleagues to increase walking during their daily commute. The intervention used nine specific BCTs: Intention formation, barrier identification, specific goal setting, instruction, general encouragement, self-monitoring of behaviour social support, review of behavioural goals and relapse prevention. Digitally recorded interviews were undertaken with 22 employees, eight of whom were Walk to Work promoters to understand their views and experiences of using these techniques. The Framework method of data management and constant comparison were used to analyse the data and identify key themes. RESULTS: For each individual BCT, there appeared to be people who found it useful in helping them to increase walking to work and others who did not. Following training, the Walk to Work promoters varied in the extent to which they were able to fulfil their role: additional support and encouragement during the 10-week intervention may be required for the promoters to maintain motivation. Wider contextual (economic climate, unprecedented wet weather) and organisational (workload, car parking facilities) issues were identified that influenced the delivery of, and response to, the intervention. CONCLUSIONS: Walk to work interventions employing BCTs should include sufficient techniques to enable participants to choose a ‘package’ to suit their needs. Additional support at organisational level should also be encouraged, and consideration given to wider contextual factors that impinge on the delivery of, and response to, the intervention. TRIAL REGISTRATION: ISRCTN72882329. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2458-14-868) contains supplementary material, which is available to authorized users

The angiogenic receptor KDR is widely distributed in human tissues and tumours and relocates intracellularly on phosphorylation. An immunohistochemical study.

AIMS: Angiogenesis is an important factor in tumour growth and metastasis. Vascular endothelial growth factor receptor 2 (VEGFR-2) or KDR plays a crucial role in angiogenesis. The aim of this study was to raise and characterize antibodies against phosphorylated KDR which could be used for studies on human tissues to assess KDR activation and novel inhibitors of KDR activation in clinical trials. METHODS AND RESULTS: Three monoclonal antibodies and one rabbit polyclonal antiserum were produced. The specificity of the antibodies was confirmed by ELISA. One of the mouse antibodies and the rabbit polyclonal antiserum reacted with a 200-kDa band on a Western blot of human umbilical vein endothelial cell (HUVEC) lysates, the molecular weight of KDR. Immunohistochemical staining showed that phosphorylated KDR is present in a wide variety of normal tissues including liver, colon and placenta, and is not restricted to endothelium. It was also present in a number of human tumours including breast carcinomas, colonic carcinomas and non-Hodgkin's lymphomas. The pattern of staining was membranous, cytoplasmic and nuclear. CONCLUSIONS: This study has shown that phosphorylated KDR is present in a wide variety of tumour and tissue types and is not confined to endothelium

Hadronic spectroscopy with Wilson valence quarks

We present preliminary results on hadronic spectrum measurements by the High Energy Monte Carlo Grand Challenge (HEMCGC) collaboration. The simulation, on a 124 lattice, uses the hybrid molecular dynamics algorithm with two flavors of staggered fermions at two quark mass values and 6/g2 = 5.6. This measurement uses Wilson valence quarks at three values of the hopping parameter on a lattice that is doubled in the time direction. Our work allows a comparative study of these two types of lattice fermions at the parameters used, and provides a check on whether the continuum limit has been reached. The results exhibit the correct trends as the chiral limit is approached. © 1990

The Well London program--a cluster randomized trial of community engagement for improving health behaviors and mental wellbeing: baseline survey results.

BACKGROUND: The Well London program used community engagement, complemented by changes to the physical and social neighborhood environment, to improve physical activity levels, healthy eating, and mental wellbeing in the most deprived communities in London. The effectiveness of Well London is being evaluated in a pair-matched cluster randomized trial (CRT). The baseline survey data are reported here. METHODS: The CRT involved 20 matched pairs of intervention and control communities (defined as UK census lower super output areas (LSOAs); ranked in the 11% most deprived LSOAs in London by the English Indices of Multiple Deprivation) across 20 London boroughs. The primary trial outcomes, sociodemographic information, and environmental neighbourhood characteristics were assessed in three quantitative components within the Well London CRT at baseline: a cross-sectional, interviewer-administered adult household survey; a self-completed, school-based adolescent questionnaire; a fieldworker completed neighborhood environmental audit. Baseline data collection occurred in 2008. Physical activity, healthy eating, and mental wellbeing were assessed using standardized, validated questionnaire tools. Multiple imputation was used to account for missing data in the outcomes and other variables in the adult and adolescent surveys. RESULTS: There were 4,107 adults and 1,214 adolescent respondents in the baseline surveys. The intervention and control areas were broadly comparable with respect to the primary outcomes and key sociodemographic characteristics. The environmental characteristics of the intervention and control neighborhoods were broadly similar. There was greater between-cluster variation in the primary outcomes in the adult population compared to the adolescent population. Levels of healthy eating, smoking, and self-reported anxiety/depression were similar in the Well London adult population and the national Health Survey for England. Levels of physical activity were higher in the Well London adult population but this is likely to be due to the different measurement tools used in the two surveys. CONCLUSIONS: Randomization of social interventions such as Well London is acceptable and feasible and in this study the intervention and control arms are well-balanced with respect to the primary outcomes and key sociodemographic characteristics. The matched design has improved the statistical efficiency of the study amongst adults but less so amongst adolescents. Follow-up data collection will be completed 2012

Glueballs and topological charge in the presence of dynamical quarks

We have estimated the string tension and the masses of the 0++ and 2++ glueballs in lattice QCD with 2 light flavours of staggered quarks. In addition we have measured the topological charge and hence susceptibility of our gauge field configurations. The simulations were performed at 6/g2 = 5.6 and quark masses m = 0.01 and 0.025 (lattice units) on lattice sizes ranging from 124 to 164. © 1991