‘Making every contact count’ with patients with musculoskeletal conditions : a qualitative exploration of acceptability to physiotherapists

Funding Information: The authors would like to thank the participants for their contribution to this research. The lead researcher, Amelia Parchment, would also like to thank Funds for Women Graduates for awarding her with a grant enabling her to complete this study, within a programme of research, following severe disruptions caused by the COVID-19 pandemic. Funding PhD studentship funded by University of Bath and Health Education England.Peer reviewedPublisher PD

How useful is the Making Every Contact Count Healthy Conversation Skills approach for supporting people with musculoskeletal conditions?

Funding: PhD studentship funded by University of Bath and Health Education England. Ethical approvals were granted by the NHS Health Research Authority (REC reference: 20/HRA/2919) and University of Bath’s Research Ethics Approval Committee for Health (reference: EP 19/20 057).Peer reviewedPublisher PD

Editing Team: Markus Fiedler

and contributions of the FIA community on the important research topics that should be addressed for the Framework Programme 8 research programmes broadly grouped around three main concerns; economic and business interests; societal interests and challenges; technical disruptions and capabilities. The contents of this roadmap originate with the community of researchers working on all aspects of the Future Internet and meet to share and discuss ideas through the Future Internet Assembly through an open consultation of research projects who participate in FIA. This roadmap is primarily concerned with identifying research that can be carried out in the second half of this decade and which will have an impact in 2020 and beyond. By ‘impact ’ we mean will result in products, services, systems, capabilities, that come to market and are available and deployed in that timeframe The approach adopted in this report is to integrate contributions across the entire space of future Internet research with the aim of bringing out the vision for how and where the Internet will make a significant difference in the future and identifying the broad challenges and gaps, and identifying the solutions and research needs in the future. In this report we have summarised and grouped ideas with the aim of identifying the strong themes and consistent challenges that emerge looking acros

The role of synovial macrophages and macrophage-produced cytokines in driving aggrecanases, matrix metalloproteinases, and other destructive and inflammatory responses in osteoarthritis

There is an increasing body of evidence that synovitis plays a role in the progression of osteoarthritis and that overproduction of cytokines and growth factors from the inflamed synovium can influence the production of degradative enzymes and the destruction of cartilage. In this study, we investigate the role of synovial macrophages and their main proinflammatory cytokines, interleukin (IL)-1 and tumour necrosis factor-alpha (TNF-α), in driving osteoarthritis synovitis and influencing the production of other pro- and anti-inflammatory cytokines, production of matrix metalloproteinases, and expression of aggrecanases in the osteoarthritis synovium. We established a model of cultures of synovial cells from digested osteoarthritis synovium derived from patients undergoing knee or hip arthroplasties. By means of anti-CD14-conjugated magnetic beads, specific depletion of osteoarthritis synovial macrophages from these cultures could be achieved. The CD14(+)-depleted cultures no longer produced significant amounts of macrophage-derived cytokines like IL-1 and TNF-α. Interestingly, there was also significant downregulation of several cytokines, such as IL-6 and IL-8 (p < 0.001) and matrix metalloproteinases 1 and 3 (p < 0.01), produced chiefly by synovial fibroblasts. To investigate the mechanisms involved, we went on to use specific downregulation of IL-1 and/or TNF-α in these osteoarthritis cultures of synovial cells. The results indicated that neutralisation of both IL-1 and TNF-α was needed to achieve a degree of cytokine (IL-6, IL-8, and monocyte chemoattractant protein-1) and matrix metalloproteinase (1, 3, 9, and 13) inhibition, as assessed by enzyme-linked immunosorbent assay and by reverse transcription-polymerase chain reaction (RT-PCR), similar to that observed in CD14(+)-depleted cultures. Another interesting observation was that in these osteoarthritis cultures of synovial cells, IL-1β production was independent of TNF-α, in contrast to the situation in rheumatoid arthritis. Using RT-PCR, we also demonstrated that whereas the ADAMTS4 (a disintegrin and metalloprotease with thrombospondin motifs 4) aggrecanase was driven mainly by TNF-α, ADAMTS5 was not affected by neutralisation of IL-1 and/or TNF-α. These results suggest that, in the osteoarthritis synovium, both inflammatory and destructive responses are dependent largely on macrophages and that these effects are cytokine-driven through a combination of IL-1 and TNF-α

Sleep duration and risk of fatal and nonfatal stroke: a prospective study and meta-analysis.

OBJECTIVE: To study the association between sleep duration and stroke incidence in a British population and to synthesize our findings with published results through a meta-analysis. METHODS: The prospective study included 9,692 stroke-free participants aged 42-81 years from the European Prospective Investigation into Cancer-Norfolk cohort. Participants reported sleep duration in 1998-2000 and 2002-2004, and all stroke cases were recorded until March 31, 2009. For the meta-analysis, we searched Ovid Medline, EMBASE, and the Cochrane Library for prospective studies published until May 2014, and pooled effect estimates using a weighted random-effect model. RESULTS: After 9.5 years of follow-up, 346 cases of stroke occurred. Long sleep was significantly associated with an increased risk of stroke (hazard ratio [HR] = 1.46 [95% confidence interval (CI) 1.08, 1.98]) after adjustment for all covariates. The association remained robust among those without preexisting diseases and those who reported sleeping well. The association for short sleep was smaller (and not statistically significant) (HR = 1.18 [95% CI 0.91, 1.53]). There was a higher stroke risk among those who reported persistently long sleep or a substantial increase in sleep duration over time, compared to those reporting persistently average sleep. These were compatible with the pooled HRs from an updated meta-analysis, which were 1.15 (1.07, 1.24) and 1.45 (1.30, 1.62) for short and long sleep duration, respectively. CONCLUSIONS: This prospective study and meta-analysis identified prolonged sleep as a potentially useful marker of increased future stroke risk in an apparently healthy aging population.The design and conduct of the EPIC-Norfolk study was supported by program grants from the Medical Research Council of the United Kingdom (grants G9502233 and G1000143) and Cancer Research UK (grants SP2024/0204 and C864/A14136). Ms. Leng is supported by Cambridge Commonwealth, European & International Trusts. Prof. Cappuccio leads the Sleep Health & Society Programme at the University of Warwick supported, in part, by the University of Warwick RDF and IAS. It has received funding by the NHS National Workforce Projects and the Economic & Social Research Council (ES/K002910/1).This is the final published version. It first appeared at http://www.neurology.org/content/early/2015/02/25/WNL.0000000000001371.short

Characterizing the variability and meteorological drivers of wind power and solar power generation over Africa

Sub-Saharan Africa (SSA) has the lowest energy access rates in the world, which poses a key barrier to power system development. Deployment of renewables, including wind and solar power, will play a key role in expanding electricity supply across SSA: distributed generation (enabling access for remote communities), cost-effectiveness and low emissions are key advantages. However, renewable generation is weather dependent; therefore, including more renewables increases the amount of meteorologically driven variability in the power system. Two countries in SSA are chosen for detailed investigation of this meteorologically driven variability: Senegal in West Africa and Kenya in East Africa. These are chosen due to being areas of dense population, where there is operational wind and solar power, and plans for regional expansion. In Senegal, solar generation is fairly consistent throughout the year, while wind generation exhibits strong seasonality, with a peak in the boreal spring. Low wind and solar power generation days during the boreal summer are found to be related to the passage of African Easterly Waves. Over Kenya, both wind and solar generation exhibit seasonal variability, with wind generation peaking during boreal autumn, and solar generation at a minimum during boreal summer. Inter-annual variability in generation is greater over Kenya than over Senegal; the El Nino Southern Oscillation is found to impact wind and solar generation over Kenya. El Nino phases are associated with lower wind and solar generation in October–December over Kenya, but higher generation in July–September. This improved understanding of variability will assist system planners in designing reliable future energy system

Sleep duration and risk of fatal and nonfatal stroke : a prospective study and meta-analysis

Objective: To study the association between sleep duration and stroke incidence in a British population and to synthesize our findings with published results through a meta-analysis. Methods: The prospective study included 9,692 stroke-free participants aged 42-81 years from the European Prospective Investigation into Cancer-Norfolk cohort. Participants reported sleep duration in 1998-2000 and 2002-2004, and all stroke cases were recorded until March 31, 2009. For the meta-analysis, we searched Ovid Medline, EMBASE, and the Cochrane Library for prospective studies published until May 2014, and pooled effect estimates using a weighted random-effect model. Results: After 9.5 years of follow-up, 346 cases of stroke occurred. Long sleep was significantly associated with an increased risk of stroke (hazard ratio [HR] = 1.46 [95% confidence interval (CI) 1.08, 1.98]) after adjustment for all covariates. The association remained robust among those without preexisting diseases and those who reported sleeping well. The association for short sleep was smaller (and not statistically significant) (HR = 1.18 [95% CI 0.91, 1.53]). There was a higher stroke risk among those who reported persistently long sleep or a substantial increase in sleep duration over time, compared to those reporting persistently average sleep. These were compatible with the pooled HRs from an updated meta-analysis, which were 1.15 (1.07, 1.24) and 1.45 (1.30, 1.62) for short and long sleep duration, respectively. Conclusions: This prospective study and meta-analysis identified prolonged sleep as a potentially useful marker of increased future stroke risk in an apparently healthy aging population

Daytime napping and increased risk of incident respiratory diseases: symptom, marker, or risk factor?

BACKGROUND: We have identified a strong association between daytime napping and increased mortality risk from respiratory diseases, but little is known about the relationship between daytime napping and respiratory morbidity. METHODS: Data were drawn from the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort. Participants reported napping habits during 1998-2000 and were followed up for respiratory disease hospital admissions until March 2009. Cox proportional hazards regression was used to examine the association between daytime napping and respiratory disease incidence risk. RESULTS: The study sample included 10,978 men and women with a mean age of 61.9 years, and a total of 946 incident respiratory disease cases were recorded. After adjustment for age, sex, social class, education, marital status, employment status, nightshift work, body mass index, physical activity, smoking, alcohol intake, self-reported general health, hypnotic drug use, habitual sleep duration, and preexisting health conditions, daytime napping was associated with an increase in the overall respiratory disease incidence risk (hazard ratio (HR) = 1.32, 95% confidence interval (CI) 1.15, 1.52 for napping <1 h; HR = 1.54, 95% CI 1.14, 2.09 for napping ≥1 h). This association was more pronounced for lower respiratory diseases, especially for the risk of chronic lower respiratory diseases (HR = 1.52, 95% CI: 1.18, 1.96 for napping <1 h; HR = 1.72, 95% CI: 1.01, 2.92 for napping ≥1 h, overall p = 0.003). CONCLUSIONS: Excessive daytime napping might be a useful marker of future respiratory disease incidence risk. Further studies are required to confirm these findings and help understand potential mechanisms.Medical Research Council (Grant IDs: G9502233, G1000143); Cancer Research UK (Grant IDs: SP2024/0204, C864/A14136)This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.sleep.2016.06.01

Daytime napping and the risk of all-cause and cause-specific mortality: a 13-year follow-up of a British population.

Epidemiologic studies have reported conflicting results on the relationship between daytime napping and mortality risk, and there are few data on the potential association in the British population. We investigated the associations between daytime napping and all-cause or cause-specific mortality in the European Prospective Investigation Into Cancer-Norfolk study, a British population-based cohort study. Among the 16,374 men and women who answered questions on napping habits between 1998 and 2000, a total of 3,251 died during the 13-year follow-up. Daytime napping was associated with an increased risk of all-cause mortality (for napping less than 1 hour per day on average, hazard ratio = 1.14, 95% confidence interval: 1.02, 1.27; for napping 1 hour or longer per day on average, hazard ratio = 1.32, 95% confidence interval: 1.04, 1.68), independent of age, sex, social class, educational level, marital status, employment status, body mass index, physical activity level, smoking status, alcohol intake, depression, self-reported general health, use of hypnotic drugs or other medications, time spent in bed at night, and presence of preexisting health conditions. This association was more pronounced for death from respiratory diseases (for napping less than 1 hour, hazard ratio = 1.40, 95% confidence interval: 0.95, 2.05; for napping 1 hour or more, hazard ratio = 2.56, 95% confidence interval: 1.34, 4.86) and in individuals 65 years of age or younger. Excessive daytime napping might be a useful marker of underlying health risk, particularly of respiratory problems, especially among those 65 years of age or younger. Further research is required to clarify the nature of the observed association.The funding sources did not have a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript

Daytime napping, sleep duration and serum C reactive protein: a population-based cohort study.

OBJECTIVES: To explore whether daytime napping and sleep duration are linked to serum C reactive protein (CRP), a pro-inflammatory marker, in an older aged British population. DESIGN: Cross-sectional study. SETTING: European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk study. PARTICIPANTS: A total of 5018 men and women aged 48-92 years reported their sleep habits and had serum CRP levels measured. OUTCOME AND MEASURES: CRP was measured (mg/L) during 2006-2011 in fresh blood samples using high-sensitivity methods. Participants reported napping habits during 2002-2004, and reported sleep quantity during 2006-2007. Multivariable linear regression models were used to examine the association between napping and log-transformed CRP, and geometric mean CRP levels were calculated. RESULTS: After adjustment for age and sex, those who reported napping had 10% higher CRP levels compared with those not napping. The association was attenuated but remained borderline significant (β=0.05 (95% CI 0.00 to 0.10)) after further adjustment for social class, education, marital status, body mass index, physical activity, smoking, alcohol intake, self-reported health, pre-existing diseases, systolic blood pressure, hypnotic drug use, depression and in women-only hormone replacement therapy use. The geometric means (95% CI) of CRP levels were 2.38 (2.29 to 2.47) mg/L and 2.26 (2.21 to 2.32) mg/L for those who reported napping and no napping, respectively. A U-shaped association was observed between time spent in bed at night and CRP levels, and nighttime sleep duration was not associated with serum CRP levels. The association between napping and CRP was stronger for older participants, and among extremes of time spent in bed at night. CONCLUSIONS: Daytime napping was associated with increased CRP levels in an older aged British population. Further studies are needed to determine whether daytime napping is a cause for systemic inflammation, or if it is a symptom or consequence of underlying health problems.The design and conduct of the EPIC-Norfolk study and collection and management of the data was supported by programme grants from the Medical Research Council UK (G9502233, G0300128) and Cancer Research UK (C865/A2883). YL is supported by the Cambridge Overseas Trust. FPC leads the Sleep Health & Society Programme at the University of Warwick supported, in part, by the University of Warwick RDF and IAS. It has received funding by the NHS National Workforce Projects and the Economic & Social Research Council (ES/K002910/1).This is the final version. It was first published by BMJ Group at http://bmjopen.bmj.com/content/4/11/e006071.full