Spinal cord injury and physical activity: health, well-being and (false) hope

It is vital that people with spinal cord injury (SCI) maintain a physically active lifestyle to promote lifelong health and well-being. Yet despite these benefits, within hospital rehabilitation and upon discharge into the community, people with SCI are largely inactive. Physiotherapists in SCI rehabilitation have been identified as the healthcare professionals (HCPs) ideally placed to promote a physically active lifestyle. However, to successfully engage people with SCI in physical activity (PA), physiotherapists have to manage their hopes and expectations of SCI rehabilitation. With all this in mind, the purpose of this thesis was to explore the role of PA for people with SCI in hospital rehabilitation and in the community. The first aim of this research was to explore the barriers, benefits and facilitators of PA for people with SCI. The second aim was to examine how hopes and expectations are managed by the physiotherapists in SCI rehabilitation and by health practitioners in a community-based leisure time physical activity (LTPA) setting. The third aim was to propose improvement to LTPA promotion for people with SCI. These aims were addressed through: 1) a meta-synthesis of the qualitative literature to identify the barriers, benefits and facilitators of LTPA for people with SCI; 2) an examination of the role of LTPA in SCI rehabilitation; and 3) an exploration of experiences of participants with SCI, and their trainers in a new type of LTPA; activity-based rehabilitation (ABR). Framed by interpretivism, data were analysed by thematic analysis and dialogical narrative analysis. This thesis has made an original and significant contribution to the literature by revealing a deep understanding of factors that constrain and facilitate physically active lifestyles for people with SCI. For example, this research has uniquely demonstrated the role of pleasure in facilitating continued engagement in LTPA. Furthermore, this thesis identified that despite valuing the role of PA for people with SCI, active promotion of PA remains largely absent from physiotherapy practice. The dilemmas of promoting PA for the physiotherapists in SCI centres included a lack of training and education in health promotion and a concern over the false hope of recovery from LTPA opportunities such as ABR. To try and avoid false hope of recovery, the physiotherapists drew upon the therapeutic plot of acceptance and employed therapeutic actions to guide patients towards realistic hopes and expectations. An identification of three narrative types operating in ABR did reveal that some clients were exercising in the hope to walk again. However, the trainers were not preoccupied with acceptance as they also tried to avoid false hopes of ABR. In light of these findings there are several practical recommendations for people with SCI, HCPs such as physiotherapists, the health care system and other health practitioners in community based LTPA opportunities. These practical implications are aimed at improving PA promotion and reducing the barriers to PA for people with SCI. For example, there is a need for more effective knowledge translation across the macro, meso and micro fields. At the macro level meaningful guidelines on PA for people with SCI need to be developed and embedded into UK and Ireland policies if they are to be received and utilised by physiotherapists in SCI rehabilitation and health practitioners in the community. At the meso and micro level appropriate training and education need to be delivered to physiotherapists on PA and SCI to equip them with sufficient knowledge to prescribe and promote PA. Furthermore, the knowledge on PA shared with physiotherapists needs to include the diversity of LTPA opportunities available to people with SCI including ABR. Closer communication and engagement should be implemented at the micro level between physiotherapists in SCI centres and the health practitioners working in community initiatives such as ABR to confront issues regarding hope. In addition to knowledge translation practices, there needs to be support within the healthcare system to facilitate a physically active lifestyle for people with SCI. Equally, a more critical attitude to PA promotion is called for in terms of the possible adverse consequences

Understanding physical activity participation in spinal cord injured populations: three narrative types for consideration

The aim of this study was to identity the types of physical activity narratives drawn upon by active spinal injured people. More than 50 h of semi-structured life-story interview data, collected as part of larger interdisciplinary program of disability lifestyle research, was analysed for 30 physically active male and female spinal cord injury (SCI) participants. A structural narrative analysis of data identified three narrative types which people with SCI draw on: (1) exercise is restitution, (2) exercise is medicine, and (3) exercise is progressive redemption. These insights contribute new knowledge by adding a unique narrative perspective to existing cognitive understanding of physical activity behaviour in the spinal cord injured population. The implications of this narrative typology for developing effective positive behavioural change interventions are critically discussed. It is concluded that the identified narratives types may be constitutive, as well as reflective, of physical activity experiences and therefore may be a useful tool on which to base physical activity promotion initiatives

Exercise is medicine? Most of the time for most; but not always for all

Based on extensive research on the relationship between exercise and health, exercise as a form of medicine is a powerful concept of growing popularity within healthcare, academia and policy. Proponents of this exercise is medicine (EiM) movement frame exercise as a panacea for a variety of health issues and uncritically promote exercise as good for all. Two clinical populations particularly influenced by the EiM agenda are spinal cord injury (SCI) and arthritis. The purpose of this research was to explore how individuals with SCI and arthritis personally make sense of their exercise experiences. Data were collected through semi-structured interviews with participants with SCI and 20 participants with arthritis. Following a thematic narrative analysis, three patterns were identified across the whole data set. These were: 1) exercise and restitution; 2) exercise and pain; and 3) exercise and pleasure. Taken together, these results provide new knowledge regarding the impact of exercise that both align with, and contrast, the dominant EiM discourse. When exercise is perceived as ‘medicine’, stories of exercise participation spoke of cure, and restitution, rather than health and well-being. Pain was an unwelcomed side effect of exercise participation for some, and had a detrimental impact upon motivation and engagement. Lastly, a focus upon the medicinal benefits of exercise did not reflect the multiple pleasures experienced through exercise participation. Thus, health professionals, academics and policy makers need to prescribe to more ethical forms of exercise promotion that may lead to more efficacious, person-sensitive interventions

Cartoons for e-health informatics

Not only is Hepatitis B serology often misunderstood because of its complex serological implications, but advances in medical science have revolutionised screening and treatment of hepatitis B. To maximise such evolution however, this new information must be relayed effectively and efficiently to current and future medical professionals. Cartoons have been well regarded as a teaching tool in a variety of different settings as is the use of web based technology. Therefore the delivery of a cartoon based learning tool, accessed via on-line learning modules was considered a novel and potentially effective way of disseminating new knowledge. To increase health professionals’ understanding of hepatitis B serology and skill in interpreting the tests that indicate the appropriate treatment, a cartoon series was developed. The cartoons are located on an online educational website and include characters that represent the different antibodies and antigens associated with hepatitis B. The cartoon characters are involved in a series of adventures that represent the various phases of hepatitis B infection, and the paper describes their development. Subsequent research demonstrated that exposure to the online cartoon based learning tool indicates that they are a fun and useful way to increase knowledge

Sources of Airborne Endotoxins in Ambient Air and Exposure of Nearby Communities—A Review

Endotoxin is a bioaerosol component that is known to cause respiratory effects in exposed populations. To date, most research focused on occupational exposure, whilst much less is known about the impact of emissions from industrial operations on downwind endotoxin concentrations. A review of the literature was undertaken, identifying studies that reported endotoxin concentrations in both ambient environments and around sources with high endotoxin emissions. Ambient endotoxin concentrations in both rural and urban areas are generally below 10 endotoxin units (EU) m−3; however, around significant sources such as compost facilities, farms, and wastewater treatment plants, endotoxin concentrations regularly exceeded 100 EU m−3. However, this is affected by a range of factors including sampling approach, equipment, and duration. Reported downwind measurements of endotoxin demonstrate that endotoxin concentrations can remain above upwind concentrations. The evaluation of reported data is complicated due to a wide range of different parameters including sampling approaches, temperature, and site activity, demonstrating the need for a standardised methodology and improved guidance. Thorough characterisation of ambient endotoxin levels and modelling of endotoxin from pollution sources is needed to help inform future policy and support a robust health-based risk assessment process

Meconium Atazanavir Concentrations and Early Language Outcomes in HIV-Exposed, Uninfected Infants with Prenatal Atazanavir Exposure

This is not the published version.OBJECTIVE: To investigate whether prenatal atazanavir (ATV) exposure, assessed by meconium antiretroviral quantification, predicts early child language outcomes. Prenatal ATV exposure previously was associated with poorer language development in one-year-olds. METHODS: Pregnant women with HIV and their uninfected infants enrolled in the SMARTT study. Meconium antiretroviral concentrations were quantified by liquid chromatography-tandem mass spectrometry. Language development at 1 year was assessed with MacArthur-Bates Communicative Development Inventory (CDI) and Bayley Scales of Infant and Toddler Development—Third Edition (Bayley-III). Late language emergence (LLE) was defined as ≥ one of four CDI scores ≤10th percentile for age. Associations between fetal ATV exposure timing and duration, meconium ATV concentration, and language outcomes were evaluated, adjusting for potential confounders. RESULTS: Through 2013, meconium samples were available from 175 of 432 infants with prenatal ATV exposure. Valid Bayley-III (n=93) and CDI (n=106) assessments also were available. After adjustment for potential confounders, higher ATV meconium concentrations were associated with lower LLE risk (P=0.04), and cumulative ATV exposure duration also was associated with higher Bayley-III Language scores (P=0.03). Maternal ATV duration and initiation week correlated with ATV meconium concentrations (positively and negatively, respectively). CONCLUSIONS: Higher meconium ATV concentrations were protective against developmental language delays at 1 year, suggesting the importance of fetal ATV detoxification into meconium. This information supports ATV exposure safety for infant language development. ATV is a preferred ARV for pregnant women with HIV, suggesting the importance of ATV safety investigations. Additionally, further pursuit of the influences on language development in HEU infants is required

A Controlled Study on the Characterisation of Bioaerosols Emissions from Compost

Bioaerosol emissions arising from biowaste treatment are an issue of public concern. To better characterise the bioaerosols, and to assess a range of measurement methods, we aerosolised green waste compost under controlled conditions. Viable and non-viable Andersen samplers, cyclone samplers and a real time bioaerosol detection system (Spectral Intensity Bioaerosol Sensor (SIBS)) were deployed simultaneously. The number-weighted fraction of fluorescent particles was in the range 22–26% of all particles for low and high emission scenarios. Overall fluorescence spectral profiles seen by the SIBS exhibited several peaks across the 16 wavelength bands from 298 to 735 nm. The size-fractionated endotoxin profile showed most endotoxin resided in the 2.1–9 μm aerodynamic diameter fraction, though up to 27% was found in a finer size fraction. A range of microorganisms were detected through culture, Matrix Assisted Laser Desorption and Ionisation Time of Flight Mass Spectrometry (MALDI-TOF) and quantitative polymerase chain reaction (qPCR), including Legionella pneumophila serogroup 1. These findings contribute to our knowledge of the physico-chemical and biological characteristics of bioaerosols from composting sites, as well as informing future monitoring approaches and data interpretation for bioaerosol measurement

Evaluation of Risk for Late Language Emergence after In Utero Antiretroviral Drug Exposure in HIV-exposed Uninfected Infants

This is not the published version.BACKGROUND Combination antiretroviral (cARV) regimens are recommended for pregnant women with HIV to prevent perinatal HIV transmission. Safety is a concern for infants who were HIV-exposed but uninfected (HEU), particularly for neurodevelopmental problems, such as language delays. METHODS We studied late language emergence (LLE) in HEU children enrolled in a US-based prospective cohort study. LLE was defined as a caregiver-reported score ≤ 10th percentile in any of 4 domains of the MacArthur-Bates Communicative Development Inventory for one-year-olds and as ≥1 standard deviation below age-specific norms for the Ages and Stages Questionnaire for two-year-olds. Logistic regression models were used to evaluate associations of in utero cARV exposure with LLE, adjusting for infant, maternal, and environmental characteristics. RESULTS 1,129 language assessments were conducted among 792 one- and two-year-olds (50% male, 62% black, and 37% Hispanic). Overall, 86% had in utero exposure to cARV and 83% to protease inhibitors. LLE was identified in 26% of one-year-olds and 23% of two-year-olds, with higher rates among boys. In adjusted models, LLE was not associated with maternal cARV or ARV drug classes in either age group. Among cARV-exposed one-year-olds, increased odds of LLE was observed for those exposed to atazanavir (aOR=1.83, 95% CI=1.10-3.04), particularly after the first trimester (aOR=3.56, p=0.001), compared to atazanavir-unexposed infants. No associations of individual ARV drugs with LLE were observed among two-year-olds. CONCLUSIONS In utero cARV exposure showed little association with LLE, except for a higher risk of language delay observed in one-year-old infants with atazanavir exposure

Language Impairment in Children Perinatally Infected with HIV Compared to Children Who Were HIV-Exposed and Uninfected

OBJECTIVE: To investigate risk for language impairment in children perinatally infected or exposed to HIV. METHOD: We evaluated the prevalence of language impairment (LI) in 7–16 year old children with perinatal HIV infection (HIV+) compared to children HIV-exposed and uninfected (HEU), using a comprehensive standardized language test (CELF-4). LI was classified as primary LI (Pri-LI) (monolingual English exposure and no cognitive or hearing impairment), concurrent LI (Con-LI) (cognitive or hearing impairment), or no LI. Associations of demographic, caregiver, HIV disease and antiretroviral treatment (ART) factors with LI category were evaluated using univariate and multivariable logistic regression models. RESULTS: Of 468 children with language assessments, 184 (39%) had LI. No difference was observed by HIV infection status for overall LI or for Pri-LI or Con-LI; mean (SD) CELF-4 scores were 88.5 (18.4) for HIV+ vs 87.5 (17.9) for HEU. After adjustment, Black children had higher odds of Pri-LI vs no LI (aOR=2.43, p=0.03). Children who were Black, Hispanic, had a caregiver with low education or low IQ, or a non-biological parent as caregiver had higher odds of Con-LI vs no LI. Among HIV+ children, viral load >400 copies/ml (aOR=3.04, p<0.001), CDC Class C (aOR=2.19, p=0.02) and ART initiation <6 months of age (aOR=2.12, p=0.02) were associated with higher odds of Con-LI vs. no LI. CONCLUSIONS: Children perinatally exposed to HIV are at high risk for LI, but such risk was not increased for youth with HIV. Risk factors differed for Pri-LI and Con-LI