A brilliant thing...just doing my own little bit

It’s almost impossible to go to the doctor or open a newspaper without being told that physical exercise is good for us. The World Health Organisation (WHO 2010) says that regular, moderate intensity physical activity can have significant health benefits, such as reducing the risk of cardiovascular disease, diabetes, colon and breast cancer, and depression. But there is also evidence that exercise can have more specific health benefits for people with dementia, for example by improving quality of life, neurocognitive function and affective symptoms (mood), and that it can possibly influence the rate of cognitive decline (Erikson 2011; Scarmeas et al 2011). This led to a collaboration between the Liverpool-based exercise service Liveability and a European research project called Innovate Dementia to evaluate the role of exercise for people with dementia. Liveability is a NHS nurse-led award winning service which provides instructor-led exercise classes and gym sessions to the over-50s in the south of the city. In general, Liveability is designed to deliver health messages, increase physical activity and reduce social isolation by offering structured exercise classes followed by opportunities for social interaction between participants. In the dementia collaboration, the key aim was to increase access to Liveability for people living with the condition and to enable them to take a full part in the programme

Chronic Household Air Pollution Exposure Is Associated with Impaired Alveolar Macrophage Function in Malawian Non-Smokers

Background Household air pollution in low income countries is an important cause of mortality from respiratory infection. We hypothesised that chronic smoke exposure is detrimental to alveolar macrophage function, causing failure of innate immunity. We report the relationship between macrophage function and prior smoke exposure in healthy Malawians. Methods Healthy subjects exposed daily to cooking smoke at home volunteered for bronchoalveolar lavage. Alveolar macrophage particulate content was measured as a known correlate of smoke exposure. Phagocytosis and intraphagosomal function (oxidative burst and proteolysis) were measured by a flow cytometric assay. Cytokine responses in macrophages were compared following re-exposure in vitro to wood smoke, before and after glutathione depletion. Results Volunteers had a range of alveolar macrophage particulate loading. The macrophage capacity for phagosomal oxidative burst was negatively associated with alveolar macrophage particulate content (n = 29, r2 = 0.16, p = 0.033), but phagocytosis per se and proteolytic function were unaffected. High particulate content was associated with lower baseline CXCL8 release (ratio 0.51, CI 0.29–0.89) and lower final concentrations on re-exposure to smoke in vitro (ratio 0.58, CI 0.34–0.97). Glutathione depletion augmented CXCL8 responses by 1.49x (CI 1.02–2.17) compared with wood smoke alone. This response was specific to smoke as macrophages response to LPS were not modulated by glutathione. Conclusion Chronic smoke exposure is associated with reduced human macrophage oxidative burst, and dampened inflammatory cytokine responses. These are critical processes in lung defence against infection and likely to underpin the relationship between air pollution and pneumonia

Chronic lung disease in HIV-infected children established on antiretroviral therapy.

Respiratory disease is a major cause of morbidity and mortality in HIV-infected children. Despite antiretroviral therapy (ART), children suffer chronic symptoms. We investigated symptom prevalence, lung function, and exercise capacity among older children established on ART, and an age-matched HIV-uninfected group. A cross-sectional study in Zimbabwe of: 1) HIV-infected children aged 6-16 years receiving ART for over six months; 2) HIV-uninfected children attending primary health clinics from the same area. Standardised questionnaire, spirometry, Incremental Shuttle Walk Testing (ISWT), CD4 count, HIV viral load, and sputum culture for tuberculosis were performed. 202 HIV-infected and 150 uninfected participants (median age 11.1 years in each group) were recruited. Median age at HIV diagnosis and ART initiation was 5.5 (IQR 2.8-7.5) and 6.1 years (IQR 3.6-8.4) respectively. Median CD4 count was 726 cells/μl, and 79% had HIV viral load<400copies/ml. Chronic respiratory symptoms were rare in HIV-uninfected children (n = 1 [0.7%]), but common in HIV-infected participants (51 [25%]), especially cough (30 [15%]) and dyspnoea (30 [15%]). HIV-infected participants were more commonly previously treated for tuberculosis (76 [38%] versus 1 [0.7%], p < 0.001), had lower exercise capacity (mean ISWT distance 771m versus 889m respectively, p < 0.001), and more frequently abnormal spirometry (43 [24.3%] versus 15 [11.5%], p = 0.003) compared to HIV-uninfected participants. HIV diagnosis at an older age was associated with lung function abnormality (p = 0.025). No participant tested positive for M. tuberculosis. In children, despite ART, HIV is associated with significant respiratory symptoms and functional impairment. Understanding pathogenesis is key, as new treatment strategies are urgently required

Do third-year mental health nursing students feel prepared to assess physical health?

Background The life expectancy for people with mental health issues is significantly lower than the general population, however, their physical health needs are often unrecognised by health professionals. Aim To investigate whether third-year mental health nursing students are clinically prepared to undertake a pre-defined set of physical health checks. Method A 34-item questionnaire was completed by two cohorts of mental health nursing students in their third and final year. Participants self-reported on their competence to assess a range of physical health checks. 37 questionnaires were completed and analysed. Findings Three groups emerged: group 1 – 100% of students self-declared competence in assessments including temperature and pulse, group 2 – more than 50% of students self-declared competence in assessments including urinalysis and pulse oximetry, and group 3 – less than 50% of students self-declared competence in taking electrocardiograms and using the hydration assessment tool. Conclusion The student participants of this study were not adequately prepared to undertake a complete range of physical health assessments for people with mental health issues

Task-shifting to improve asthma education for Malawian children: a qualitative analysis

BACKGROUND Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced asthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention. METHODS We conducted six focus group discussions, including 15 children and 28 carers, and individual interviews with four lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified. RESULTS Prior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approach. DISCUSSION Asthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage. Trial registration The RCT was registered in the Pan African Clinical Trials Registry: PACTR201807211617031

Negotiations of minority ethnic rugby league players in the Cathar country of France

This article is based on new empirical, qualitative research with minority ethnic rugby league players in the southwest of France. Drawing on similar research on rugby league in the north and the south of England, the article examines how rugby league, traditionally viewed as a white, working-class male game (Collins, 2006; Denham, 2004; Spracklen, 1995, 2001) has had to re-imagine its symbolic boundaries as they are constituted globally and locally to accommodate the needs of players from minority ethnic backgrounds. In particular, the article examines the sense in which experiences of minority ethnic rugby league players in France compare with those of their counterparts in England (Spracklen, 2001, 2007), how rugby league is used in France to construct identity, and in what sense the norms associated with the imaginary community of rugby league are replicated or challenged by the involvement of minority ethnic rugby league players in France. Questions about what it means to be (provincial, national) French (Kumar, 2006) are posed, questions that relate to the role of sport in the construction of Frenchness, and in particular the role of rugby league (and union). © Copyright ISSA and SAGE Publications

What is taught about dementia in secondary schools? A survey of schools in Sussex, England (innovative practice)

Local dementia education initiatives exist in schools but it is unclear what the wider uptake of such programmes are. A self-created survey was sent to staff in a number of secondary schools (teaching ages 11-16) across Sussex, England. Sixty schools responded to the survey (response rate = 58%). While the majority of schools expressed an interest in including some form of dementia education within their school in the future, only nine schools (15%) currently had dementia education embedded within their curriculum. Despite government calls to reduce stigma and improve attitudes towards dementia, it seems very little is being taught in secondary schools on the topic

Pneumococcal colonization in healthy adult research participants in the conjugate vaccine era, United Kingdom, 2010-2017.

Pneumococcal colonization is rarely studied in adults, except as part of family surveys. We report the outcomes of colonization screening in healthy adults (non-smokers without major comorbidities or contact with children under five years) who had volunteered to take part in clinical research. Using nasal wash culture, we detected colonization in 6.5% (52/795) of volunteers. Serotype 3 was the commonest serotype (10/52). The majority of the remainder (35/52) were non-vaccine serotypes, but we also identified persistent circulation of serotypes 19A and 19F. Resistance to at least one of six antibiotics tested was found in 8/52 isolates

Energy Landscape and Global Optimization for a Frustrated Model Protein

The three-color (BLN) 69-residue model protein was designed to exhibit frustrated folding. We investigate the energy landscape of this protein using disconnectivity graphs and compare it to a Go model, which is designed to reduce the frustration by removing all non-native attractive interactions. Finding the global minimum on a frustrated energy landscape is a good test of global optimization techniques, and we present calculations evaluating the performance of basin-hopping and genetic algorithms for this system.Comparisons are made with the widely studied 46-residue BLN protein.We show that the energy landscape of the 69-residue BLN protein contains several deep funnels, each of which corresponds to a different β-barrel structure