Development of a physical activity programme for people with recently diagnosed rheumatoid arthritis

Background People with rheumatoid arthritis (RA) are less physically active (PA) than the general population and lower PA levels are associated with work disability, reduced physical function and co-morbidities. This suggests an urgent need to identify programmes that effectively promote sustainable PA to improve physical function in RA.Objectives The purpose of this research was to seek patient's views in relation to a range of potential PA programmes.Methods Focus groups were carried out with adults with RA with participants purposefully sampled to reflect a range of age and gender. Prior to commencing the research a draft interview guide was reviewed by the study Patient Research Partner and a pilot interview conducted. The interview guide was designed to explore PA support needs and experiences since diagnosis as well as motivators and facilitators to support engagement in PA. Each focus group was subsequently provided with information regarding potential PA programmes and invited to comment upon their suitability for people with a recent diagnosis of RA. Focus groups were audio recorded, transcribed and anonymised. Ethics approval for the study was obtained. Written informed consent was obtained from all participants. Thematic analysis was used to identify the main themes across the groups. Emerging themes were verified through discussion and a coding framework based on these themes developed. Themes and sub-themes were subsequently reviewed and the interpretation and analysis discussed and agreed.Results Three focus groups were conducted with 19 patients in total (15 female, 4 male); mean age (SD) 60 (±10) years; mean time (SD) since diagnosis 44 (±34) months. There was strong support for a PA programme with four key themes garnered from the focus groups:Recruitment and adherence included programme endorsement from peers and PA endorsement from health professionals; the need for support to overcome barriers to PA, such as pain and fatigue; and prompts such as text messages to improve adherence.Programme scheduling included timing with most suggesting six to 12 months following diagnosis, once a stable drug regime was established; afternoon sessions were preferred; views on frequency of sessions and duration of the programme were disparate.Programme content included support for education on relaxation and coping strategies, medication, flare, fatigue and pain; supervised exercise sessions; home exercise training; and expert physiotherapy input. Goal setting received mixed opinions with emphasis on the need to be patient-led.Programme delivery suggested group sessions were preferred by most, but not all; individual sessions in addition to the group were positively received; telephone support polarised opinion; but an accessible location was an agreed priority.Conclusions Participants supported development of a PA programme delivered at an accessible location, by physiotherapists within six to 12 months of diagnosis. Mixed views relating to delivery suggests a flexible approach may need to be developed.Disclosure of Interest None declare

Weight Status: A Predictor of the Receipt of and Interest in Health Promotion Information among College Students

Background: Negative health behaviors such as consumption of excess calories, low intake of fruits and vegetables, sedentariness and weight gain are associated with entry into college. Purpose: To determine if weight status is associated with students’ receipt of health promotion (nutrition, physical activity and stress reduction) information, and students’ interest in receiving these types of information from their college or university. Methods: Data from the Spring 2011 ACHA-NCHA II dataset was used to complete secondary data analyses. Students (N=116,254) from 148 postsecondary institutions completed the Spring 2011 ACHA-NCHA II survey. Logistic regression was used to examine the effect of BMI category on receipt of, and interest in receiving, health promotion information. Results: Approximately 32% of respondents were overweight or obese. Students in the obese class III category were the least likely to receive health promotion information and least likely to be interested in receiving the information. Conclusion: Weight status based on BMI classification is a weak predictor of the dissemination of health promotion information. The largest gaps related to the dissemination appear to be among obese students. Future research is needed to determine factors contributing to the observed gaps and strategies should be developed to reach underserved groups

An ancient river landscape preserved beneath the East Antarctic Ice Sheet

The East Antarctic Ice Sheet (EAIS) has its origins ca. 34 million years ago. Since then, the impact of climate change and past fluctuations in the EAIS margin has been reflected in periods of extensive vs. restricted ice cover and the modification of much of the Antarctic landscape. Resolving processes of landscape evolution is therefore critical for establishing ice sheet history, but it is rare to find unmodified landscapes that record past ice conditions. Here, we discover an extensive relic pre-glacial landscape preserved beneath the central EAIS despite millions of years of ice cover. The landscape was formed by rivers prior to ice sheet build-up but later modified by local glaciation before being dissected by outlet glaciers at the margin of a restricted ice sheet. Preservation of the relic surfaces indicates an absence of significant warm-based ice throughout their history, suggesting any transitions between restricted and expanded ice were rapid

UK Breastfeeding Helpline support: An investigation of influences upon satisfaction

Background Incentive or reward schemes are becoming increasingly popular to motivate healthy lifestyle behaviours. In this paper, insights from a qualitative and descriptive study to investigate the uptake, impact and meanings of a breastfeeding incentive intervention integrated into an existing peer support programme (Star Buddies) are reported. The Star Buddies service employs breastfeeding peer supporters to support women across the ante-natal, intra-partum and post-partum period. Methods In a disadvantaged area of North West England, women initiating breastfeeding were recruited by peer supporters on the postnatal ward or soon after hospital discharge to participate in an 8 week incentive (gifts and vouchers) and breastfeeding peer supporter intervention. In-depth interviews were conducted with 26 women participants who engaged with the incentive intervention, and a focus group was held with the 4 community peer supporters who delivered the intervention. Descriptive analysis of routinely collected data for peer supporter contacts and breastfeeding outcomes before and after the incentive intervention triangulated and retrospectively provided the context for the qualitative thematic analysis. Results A global theme emerged of 'incentives as connectors', with two sub-themes of 'facilitating connections' and 'facilitating relationships and wellbeing'. The incentives were linked to discussion themes and gift giving facilitated peer supporter access for proactive weekly home visits to support women. Regular face to face contacts enabled meaningful relationships and new connections within and between the women, families, peer supporters and care providers to be formed and sustained. Participants in the incentive scheme received more home visits and total contact time with peer supporters compared to women before the incentive intervention. Full participation levels and breastfeeding rates at 6-8 weeks were similar for women before and after the incentive intervention. Conclusion The findings suggest that whilst the provision of incentives might not influence women's intentions or motivations to breastfeed, the connections forged provided psycho-social benefits for both programme users and peer supporters

Understanding mosquito host choice behaviour: a new and cost-effective method of identifying the sex of human hosts in mosquito blood meals

Background: Mosquito-borne diseases are a global health problem, causing hundreds of thousands of deaths/year. Pathogens are transmitted by mosquitoes taking blood from an infected host and then feeding on a new host. Monitoring mosquito host-choice behaviour can help in many aspects of vector-borne disease control. Currently, it is possible to determine the host species and the individual human host using genotyping to match the blood profile of local inhabitants to the blood-meal found in mosquitoes. Epidemiological models generally assume biting behaviour is random, however, numerous studies have shown that certain individuals are more attractive to mosquitoes than others, due to e.g., genetic makeup and profiles of skin microbiota. Analysing blood-meals and illuminating host choice behaviour will help re-evaluate and optimise disease transmission models. Methods: We describe a new blood-meal assay that identifies the sex of the person a mosquito has bitten. The amelogenin locus (AMEL), a sex marker located on both X and Y chromosomes, was amplified by PCR in DNA extracted from Aedes aegypti and Anopheles coluzzii blood-meals. Results: Our results show that AMEL successfully amplifies up to 36 hours after a blood-meal in 63% of An. coluzzii and 80% of Ae. aegypti blood-meals, revealing the sex of humans that were fed on by individual mosquitoes, which enables further exploration of vector mosquito host preferences. This method was successfully tested in both Anopheles coluzzii and Aedes aegypti, important vectors of malaria and arboviruses, respectively. Conclusions: This method, developed with mosquitoes fed on volunteers, can be applied to field-caught mosquitoes where the host species, the biological sex of the human host and host diversity within blood-meals can be determined. Two important vector species were tested successfully in our laboratory experiments, demonstrating the potential of this technique to improve epidemiological models of vector-borne diseases. This viable and highly cost-effective approach has the capacity to improve our understanding of vector-borne disease transmission, specifically gender differences in exposure and attractiveness to mosquitoes. The data gathered from field-studies using our method will shape new transmission models and aid in the implementation of more effective and targeted vector control strategies by better understanding the drivers of vector-host interactions

Barriers to a healthy lifestyle for three- to four-year-old children of Australian-born and overseas-born mothers with post-gestational diabetes:An Australian qualitative study

Children of mothers affected by gestational diabetes mellitus (GDM) are at higher risk of long-term cardio-metabolic diseases. We explore the diet and physical activity knowledge and practices of Australian-born and overseas-born mothers with GDM history, for their three- to four-year-old children following antenatal health promotion education at a tertiary hospital. We conducted face-to-face, semi-structured interviews with 8 Australian-born and 15 overseas-born mothers with a history of GDM. Findings indicated that mothers of both groups were unaware of the increased health risks of their GDM for their children and could not recall receiving specific dietary or physical activity advice aimed at future child health. Their understanding of the diet and physical activity recommendations was inconsistent. Mothers of both groups expressed concern about the lack of reiteration of child health promotion messages following childbirth, particularly at postnatal follow-up visits. Diet and physical activity of the children of overseas-born mothers were adversely affected by inadequate maternal understanding of the recommendations due to language barriers, and child weight, healthy eating, and physical activity patterns derived from their home countries. We recommend enhanced health education for women with GDM on the future child health risks and their reduction by healthy lifestyle choices. This needs to be culturally relevant and reiterated after pregnancy. </jats:p

Accuracy of Digital Breast Tomosynthesis for Depicting Breast Cancer Subgroups in a UK Retrospective Reading Study (TOMMY Trial).

PURPOSE: To compare the diagnostic performance of two-dimensional (2D) mammography, 2D mammography plus digital breast tomosynthesis (DBT), and synthetic 2D mammography plus DBT in depicting malignant radiographic features. MATERIALS AND METHODS: In this multicenter, multireader, retrospective reading study (the TOMMY trial), after written informed consent was obtained, 8869 women (age range, 29-85 years; mean, 56 years) were recruited from July 2011 to March 2013 in an ethically approved study. From these women, a reading dataset of 7060 cases was randomly allocated for independent blinded review of (a) 2D mammography images, (b) 2D mammography plus DBT images, and (c) synthetic 2D mammography plus DBT images. Reviewers had no access to results of previous examinations. Overall sensitivities and specificities were calculated for younger women and those with dense breasts. RESULTS: Overall sensitivity was 87% for 2D mammography, 89% for 2D mammography plus DBT, and 88% for synthetic 2D mammography plus DBT. The addition of DBT was associated with a 34% increase in the odds of depicting cancer (odds ratio [OR] = 1.34, P = .06); however, this level did not achieve significance. For patients aged 50-59 years old, sensitivity was significantly higher (P = .01) for 2D mammography plus DBT than it was for 2D mammography. For those with breast density of 50% or more, sensitivity was 86% for 2D mammography compared with 93% for 2D mammography plus DBT (P = .03). Specificity was 57% for 2D mammography, 70% for 2D mammography plus DBT, and 72% for synthetic 2D mammography plusmDBT. Specificity was significantly higher than 2D mammography (P < .001in both cases) and was observed for all subgroups (P < .001 for all cases). CONCLUSION: The addition of DBT increased the sensitivity of 2D mammography in patients with dense breasts and the specificity of 2D mammography for all subgroups. The use of synthetic 2D DBT demonstrated performance similar to that of standard 2D mammography with DBT. DBT is of potential benefit to screening programs, particularly in younger women with dense breasts. (©) RSNA, 2015.The TOMMY Trial (a comparison of digital breast tomosynthesis with mammography in the UK Breast Screening Programme) was supported by the NIHR Health Technology Assessment Programme.This is the final published version of the article. It was originally published in Radiology (Gilbert et al., Radiology, 2015, doi:10.1148/radiol.2015142566). The final version is available at http://dx.doi.org/10.1148/radiol.201514256

Accuracy of Digital Breast Tomosynthesis for Depicting Breast Cancer Subgroups in a UK Retrospective Reading Study (TOMMY Trial)

Purpose To compare the diagnostic performance of two-dimensional (2D) mammography, 2D mammography plus digital breast tomosynthesis (DBT), and synthetic 2D mammography plus DBT in depicting malignant radiographic features. Materials and Methods In this multicenter, multireader, retrospective reading study (the TOMMY trial), after written informed consent was obtained, 8869 women (age range, 29–85 years; mean, 56 years) were recruited from July 2011 to March 2013 in an ethically approved study. From these women, a reading dataset of 7060 cases was randomly allocated for independent blinded review of (a) 2D mammography images, (b) 2D mammography plus DBT images, and (c) synthetic 2D mammography plus DBT images. Reviewers had no access to results of previous examinations. Overall sensitivities and specificities were calculated for younger women and those with dense breasts. Results Overall sensitivity was 87% for 2D mammography, 89% for 2D mammography plus DBT, and 88% for synthetic 2D mammography plus DBT. The addition of DBT was associated with a 34% increase in the odds of depicting cancer (odds ratio [OR] = 1.34, P = .06); however, this level did not achieve significance. For patients aged 50–59 years old, sensitivity was significantly higher (P = .01) for 2D mammography plus DBT than it was for 2D mammography. For those with breast density of 50% or more, sensitivity was 86% for 2D mammography compared with 93% for 2D mammography plus DBT (P = .03). Specificity was 57% for 2D mammography, 70% for 2D mammography plus DBT, and 72% for synthetic 2D mammography plusmDBT. Specificity was significantly higher than 2D mammography (P < .001in both cases) and was observed for all subgroups (P < .001 for all cases). Conclusion The addition of DBT increased the sensitivity of 2D mammography in patients with dense breasts and the specificity of 2D mammography for all subgroups. The use of synthetic 2D DBT demonstrated performance similar to that of standard 2D mammography with DBT. DBT is of potential benefit to screening programs, particularly in younger women with dense breasts. © RSNA, 2015The TOMMY Trial (a comparison of digital breast tomosynthesis with mammography in the UK Breast Screening Programme) was supported by the NIHR Health Technology Assessment Programme.This is the final published version of the article. It was originally published in Radiology (Gilbert et al., Radiology, 2015, doi:10.1148/radiol.2015142566). The final version is available at http://dx.doi.org/10.1148/radiol.201514256