Overcoming the barriers to walking for children

This paper is an output from the project CAPABLE (Children?s Activities,Perceptions and Behaviour in the Local Environment) being carried out at UCL,jointly between the Centre for Transport Studies, the Department of Psychology, theBartlett School of Planning and the Centre for Advanced Spatial Analysis. The overallaim of the project, which runs from 1 August 2004 to 31 July 2006, is to examine theinteraction between children and the local environment, including identifying howchildren use open space and streets, and why they go to some places but not others.This paper draws on results from questionnaires completed by children about theextent to which they are allowed out unaccompanied by an adult. The surveys werecarried out in four schools, two in Hertfordshire, the area immediately north ofLondon, and two in the London Borough of Lewisham. The purpose is to establish theextent to which the children are allowed by their parents to go out unaccompanied byadults. The issues covered include whether the children go out walking or cyclingwithout an adult, whether they are allowed out alone to visit friends houses, go outafter dark or to cross main roads. The results are considered in terms of the children?sage and gender, and in terms of the households? car ownership level and the strengthof its local social networks. It is found that more of the children in Hertfordshire areallowed out alone, despite the fact that the factors that seem to correlate with beingallowed out unaccompanied are stronger in Lewisham. It is concluded that this maywell be due to environmental factors, real and perceived

Setting Children Free: Children’s Independent Movement in the Local Environment

Parental concerns about children’s safety and security are restricting children’s independent exploration of the local environment. Children are being denied important opportunities to exercise, to acquire decision-making skills, such as crossing the road safely, and to develop social skills through interaction with their peers. This paper presents findings from the project CAPABLE (Children’s Activities, Perceptions And Behaviour in the Local Environment) being carried out at University College London. Based on findings from fieldwork carried out with children aged 8-11 in Cheshunt, Hertfordshire, the paper shows the effect of factors such as the number of adults at home, having an older sibling, having a car or garden at home and living near to a park on the propensity to be allowed out alone. Then it considers how being allowed out alone affects the amount of time children spend outdoors, playing with friends and watching television. The paper then uses data from children who have been fitted with physical activity monitors and GPS (Global Positioning Satellite) monitors and asked to keep diaries, to show how children’s travel behaviour differs when they are with adults from when they are not

Comparison of patient experiences of the osteoarthritis consultation with GP attitudes and beliefs to OA: a narrative review

Osteoarthritis (OA) is a common cause of disability and consultation with a GP. However, little is known about what currently happens when patients with OA consult their GP. This review aims to compare existing literature reporting patient experiences of consultations in which OA is discussed with GP attitudes and beliefs regarding OA, in order to identify any consultation events that may be targeted for intervention

Getting back to the dissecting room: an evaluation of an innovative course in musculoskeletal anatomy for UK-based rheumatology training

BackgroundThe rheumatologist relies heavily on clinical skills to diagnose diverse conditions, something that is correlated with one's knowledge of clinical anatomy. More recently, rheumatology has offered further career flexibility with opportunities to develop skills such as joint injection and musculoskeletal (MSK) ultrasound, both of which require a sound understanding of anatomy. Currently, there are no formal strategies to support competency-based anatomy learning in rheumatology in the UK. This study aimed to evaluate an innovative applied anatomy course utilizing cadaveric material, targeted at clinicians practising in rheumatology and MSK medicine.MethodsA new course was developed for rheumatologists, rheumatology trainees and allied health professionals practising rheumatology and MSK medicine, with the principal focus being on applied MSK anatomy. A questionnaire was given to course attendees and a mixed methods approach of evaluation used. Descriptive statistical data analysis was performed.ResultsThe course received overall positive feedback and statistically significant improvements in levels of confidence in anatomy (mean 52.35–83.53, p < 0.0001), injections (mean 57.65–81.18, p < 0.0001), examination of the upper limb (mean 60.59–76.47, p < 0.0001) and examination of the lower limb (mean 58.24–77.65, p < 0.0001). Course attendees also favoured a peer-assisted and multidisciplinary learning approach.ConclusionsThis study lends support for the use of cadaveric material in the teaching of postgraduate anatomy to rheumatologists. It has demonstrated a continual need for hands-on and interactive anatomy training in an ever-advancing digital world. To be successful, cadaveric learning should not be viewed in a purely ‘pre-clinical’ setting, but instead integrated with postgraduate learning

Crossing disciplines to address urban sustainability

This paper presents findings from the evaluation of Bridging the Gaps: Sustainable Urban Spaces (BTG), a novel interdisciplinary sustainability research funding program at University College London (UCL), funded by the United Kingdom Engineering and Physical Sciences Research Council (EPSRC). All of the EPSRC's Bridging the Gaps programs aim to initiate and support interdisciplinary collaboration within a university. The program at UCL was designed to create research partnerships that focus on problems in the area of sustainable urban spaces, an area that features complex problems that often overlap different academic disciplines. The program initially focused on building relationships within the three UCL faculties: The Bartlett Faculty of the Built Environment, The Faculty of Engineering Sciences, and The Faculty of Mathematical and Physical Sciences, but subsequently brought in participants from other faculties. Bridging the Gaps has brought together researchers working on different elements of a problem, allowing each of them to contribute approaches from their own discipline. This paper presents feedback from participants in the program. Respondents discuss their experience in cross disciplinary working and its importance for their work. We address the question of whether the benefits are outweighed by the complexities of crossing disciplines, and we investigate the role that programs like BTG can play in making the process easier. We also discuss the challenge of creating the conditions for interdisciplinary work and ways in which we can use our experience to minimize the barriers of crossing disciplines in the future

Clinical Utility of Random Anti–Tumor Necrosis Factor Drug–Level Testing and Measurement of Antidrug Antibodies on the Long-Term Treatment Response in Rheumatoid Arthritis

Objective: To investigate whether antidrug antibodies and/or drug non-trough levels predict the long-term treatment response in a large cohort of patients with rheumatoid arthritis (RA) treated with adalimumab or etanercept and to identify factors influencing antidrug antibody and drug levels to optimize future treatment decisions.  Methods: A total of 331 patients from an observational prospective cohort were selected (160 patients treated with adalimumab and 171 treated with etanercept). Antidrug antibody levels were measured by radioimmunoassay, and drug levels were measured by enzyme-linked immunosorbent assay in 835 serial serum samples obtained 3, 6, and 12 months after initiation of therapy. The association between antidrug antibodies and drug non-trough levels and the treatment response (change in the Disease Activity Score in 28 joints) was evaluated.  Results: Among patients who completed 12 months of followup, antidrug antibodies were detected in 24.8% of those receiving adalimumab (31 of 125) and in none of those receiving etanercept. At 3 months, antidrug antibody formation and low adalimumab levels were significant predictors of no response according to the European League Against Rheumatism (EULAR) criteria at 12 months (area under the receiver operating characteristic curve 0.71 [95% confidence interval (95% CI) 0.57, 0.85]). Antidrug antibody–positive patients received lower median dosages of methotrexate compared with antidrug antibody–negative patients (15 mg/week versus 20 mg/week; P = 0.01) and had a longer disease duration (14.0 versus 7.7 years; P = 0.03). The adalimumab level was the best predictor of change in the DAS28 at 12 months, after adjustment for confounders (regression coefficient 0.060 [95% CI 0.015, 0.10], P = 0.009). Etanercept levels were associated with the EULAR response at 12 months (regression coefficient 0.088 [95% CI 0.019, 0.16], P = 0.012); however, this difference was not significant after adjustment. A body mass index of ≥30 kg/m2 and poor adherence were associated with lower drug levels.  Conclusion: Pharmacologic testing in anti–tumor necrosis factor–treated patients is clinically useful even in the absence of trough levels. At 3 months, antidrug antibodies and low adalimumab levels are significant predictors of no response according to the EULAR criteria at 12 months

Oral abstracts 3: RA Treatment and outcomesO13. Validation of jadas in all subtypes of juvenile idiopathic arthritis in a clinical setting

Background: Juvenile Arthritis Disease Activity Score (JADAS) is a 4 variable composite disease activity (DA) score for JIA (including active 10, 27 or 71 joint count (AJC), physician global (PGA), parent/child global (PGE) and ESR). The validity of JADAS for all ILAR subtypes in the routine clinical setting is unknown. We investigated the construct validity of JADAS in the clinical setting in all subtypes of JIA through application to a prospective inception cohort of UK children presenting with new onset inflammatory arthritis. Methods: JADAS 10, 27 and 71 were determined for all children in the Childhood Arthritis Prospective Study (CAPS) with complete data available at baseline. Correlation of JADAS 10, 27 and 71 with single DA markers was determined for all subtypes. All correlations were calculated using Spearman's rank statistic. Results: 262/1238 visits had sufficient data for calculation of JADAS (1028 (83%) AJC, 744 (60%) PGA, 843 (68%) PGE and 459 (37%) ESR). Median age at disease onset was 6.0 years (IQR 2.6-10.4) and 64% were female. Correlation between JADAS 10, 27 and 71 approached 1 for all subtypes. Median JADAS 71 was 5.3 (IQR 2.2-10.1) with a significant difference between median JADAS scores between subtypes (p < 0.01). Correlation of JADAS 71 with each single marker of DA was moderate to high in the total cohort (see Table 1). Overall, correlation with AJC, PGA and PGE was moderate to high and correlation with ESR, limited JC, parental pain and CHAQ was low to moderate in the individual subtypes. Correlation coefficients in the extended oligoarticular, rheumatoid factor negative and enthesitis related subtypes were interpreted with caution in view of low numbers. Conclusions: This study adds to the body of evidence supporting the construct validity of JADAS. JADAS correlates with other measures of DA in all ILAR subtypes in the routine clinical setting. Given the high frequency of missing ESR data, it would be useful to assess the validity of JADAS without inclusion of the ESR. Disclosure statement: All authors have declared no conflicts of interest. Table 1Spearman's correlation between JADAS 71 and single markers DA by ILAR subtype ILAR Subtype Systemic onset JIA Persistent oligo JIA Extended oligo JIA Rheumatoid factor neg JIA Rheumatoid factor pos JIA Enthesitis related JIA Psoriatic JIA Undifferentiated JIA Unknown subtype Total cohort Number of children 23 111 12 57 7 9 19 7 17 262 AJC 0.54 0.67 0.53 0.75 0.53 0.34 0.59 0.81 0.37 0.59 PGA 0.63 0.69 0.25 0.73 0.14 0.05 0.50 0.83 0.56 0.64 PGE 0.51 0.68 0.83 0.61 0.41 0.69 0.71 0.9 0.48 0.61 ESR 0.28 0.31 0.35 0.4 0.6 0.85 0.43 0.7 0.5 0.53 Limited 71 JC 0.29 0.51 0.23 0.37 0.14 -0.12 0.4 0.81 0.45 0.41 Parental pain 0.23 0.62 0.03 0.57 0.41 0.69 0.7 0.79 0.42 0.53 Childhood health assessment questionnaire 0.25 0.57 -0.07 0.36 -0.47 0.84 0.37 0.8 0.66 0.4