Growing cross-sectional evidence links access to green-blue spaces with mental health benefits, but studies at an individual level and at a national population scale are scarce. This gap can be ...addressed through the Secure Anonymised Information Linkage (SAIL) Databank, which allows household-level green-blue spaces access and exposure data to be linked to individual-level health-care use.
Within the SAIL Databank, an e-cohort of the population of Wales (2008–19) was created from green-blue space metrics and the Welsh Longitudinal General Practice database. Green-blue spaces metrics (derived from satellite imagery and planning data) included average ambient greenness within 300 m of the home (designated as the Enhanced Vegetation Index) and average access to green-blue spaces (designated as the number of green-blue spaces within 1600 m of the home). A validated algorithm was applied to create a common mental health disorder flag and linked to green-blue spaces exposure (ambient greenness and access) recorded for individuals not affected by common mental health disorders. We used multivariate logistic regression models to test the hypothesis that greater green-blue spaces exposure is associated with a reduced likelihood of a flagged common mental health disorder. Subgroup analyses were done for socioeconomic deprivation.
The e-cohort comprised 2 341 591 individuals (1 193 240 men and 1 148 351 women), aged 16 or over and registered with a general practice in the SAIL Databank. After adjusting for individual and area-level covariates, a unit increase in ambient greenness around the home and access to green-blue spaces within 1600 m were associated with lower odds of a common mental health disorder (adjusted odds ratio 0·11 95% CI 0·11–0·12 for ambient greenness around the home and 0·47 0·46–0·48 for access to green-blue spaces within 1600 m). A unit increase in ambient greenness was associated with reduced odds of a common mental health disorder for residents of the most deprived areas (n=473 410; 0·22 0·20–0·24) and of the least deprived areas (n=480 424; 0·07 0·07–0·08).
People with greater exposure to green-blue spaces were less likely to develop a common mental health disorder and the effect is modified by socioeconomic deprivation. This finding has implications for both public health policy and urban planning. This large, adult-population cohort provides sufficient power to examine variations between subgroups to investigate inequalities.
The project was developed as part of independent research funded by the National Institute for Health Research (study number 16/07/07).
To determine whether patient reported outcomes improve after single stage versus two stage revision surgery for prosthetic joint infection of the hip, and to determine the cost effectiveness of these ...procedures.
Pragmatic, parallel group, open label, randomised controlled trial.
High volume tertiary referral centres or orthopaedic units in the UK (n=12) and in Sweden (n=3), recruiting from 1 March 2015 to 19 December 2018.
140 adults (aged ≥18 years) with a prosthetic joint infection of the hip who required revision (65 randomly assigned to single stage and 75 to two stage revision).
A computer generated 1:1 randomisation list stratified by hospital was used to allocate participants with prosthetic joint infection of the hip to a single stage or a two stage revision procedure.
The primary intention-to-treat outcome was pain, stiffness, and functional limitations 18 months after randomisation, measured by the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) score. Secondary outcomes included surgical complications and joint infection. The economic evaluation (only assessed in UK participants) compared quality adjusted life years and costs between the randomised groups.
The mean age of participants was 71 years (standard deviation 9) and 51 (36%) were women. WOMAC scores did not differ between groups at 18 months (mean difference 0.13 (95% confidence interval -8.20 to 8.46), P=0.98); however, the single stage procedure was better at three months (11.53 (3.89 to 19.17), P=0.003), but not from six months onwards. Intraoperative events occurred in five (8%) participants in the single stage group and 20 (27%) in the two stage group (P=0.01). At 18 months, nine (14%) participants in the single stage group and eight (11%) in the two stage group had at least one marker of possible ongoing infection (P=0.62). From the perspective of healthcare providers and personal social services, single stage revision was cost effective with an incremental net monetary benefit of £11 167 (95% confidence interval £638 to £21 696) at a £20 000 per quality adjusted life years threshold (£1.0; $1.1; €1.4).
At 18 months, single stage revision compared with two stage revision for prosthetic joint infection of the hip showed no superiority by patient reported outcome. Single stage revision had a better outcome at three months, fewer intraoperative complications, and was cost effective. Patients prefer early restoration of function, therefore, when deciding treatment, surgeons should consider patient preferences and the cost effectiveness of single stage surgery.
ISRCTN registry ISRCTN10956306.
Electronic nicotine delivery systems (ENDS), which include electronic cigarettes, or e-cigarettes, are growing in popularity, but their safety and efficacy as a smoking cessation aid are not well ...understood. Some argue that they have the potential to reduce tobacco-related morbidity and mortality and could be a useful tool for reducing tobacco-related harm. Others express concern that the health effects of ENDS use are unknown, that they may appeal to young people, and that they may encourage dual use of ENDS and traditional tobacco products. Although ENDS are a new and unregulated product, the U.S. Food and Drug Administration has proposed regulations that would deem ENDS to be subject to the Family Smoking Prevention and Tobacco Control Act, which regulates cigarettes and other tobacco products. In this position paper, the American College of Physicians offers policy recommendations on ENDS regulation and oversight, taxation, flavorings, promotion and marketing, indoor and public use, and research. This paper is not intended to offer clinical guidance or serve as an exhaustive literature review of existing ENDS-related evidence but to help direct the College, policymakers, and regulators on how to address these products.
Detection of phosphorylated proteins in tissue sections using immunohistochemistry (IHC) is a challenging task. The absence of tissue staining may be caused by either a lack of protein expression or ...a lack of protein activation via its phosphorylation. To address this problem, we employed Integrated Co-detection Workflow (ICW) protocol to analyze lung cancer tissue sections by combining in situ hybridization (ISH) with IHC. The target protein of interest was epidermal growth factor receptor (EGFR, also known as ErbB1 and HER1) which is the founding member of the ErbB family of receptor tyrosine kinases. Using phospho-specific antibodies specific for a phosphorylated site Y1173 of EGFR molecule allowed us to analyze IHC and ISH staining at a single cell level in lung cancer tissue. We have observed both a co-localization of IHC with ISH signals and ISH-positive cells lacking IHC labeling for phosphorylated EGFR. ICW appears to be a very powerful spatial biology technique for accurate localization of cancer cells with phosphorylated/activated and non-phosphorylated/nonactivated proteins.
Highlights • Heroin SA behavior is associated with differential CRF signaling gene expression. • mRNA expression differences occur in memory, reward and executive brain systems. • Differential mRNA ...expression of CRH binding protein may be regulated, in part, by CpG methylation. • The NAc is striking in having no changes in mRNA expression in CRF signaling genes. • Alignment of mPFC and Hipp may reflect coordinate CRF signaling in SA behavior.
Management of febrile neutropenia (FN) is an integral part of supportive care for patients undergoing cancer treatment. The NCCN Guidelines for Hematopoietic Growth Factors provide suggestions for ...appropriate evaluation, risk determination, prophylaxis, and management of FN. These NCCN Guidelines are intended to guide clinicians in the appropriate use of growth factors for select patients undergoing treatment of nonmyeloid malignancies. These NCCN Guidelines Insights highlight important updates to the NCCN Guidelines regarding the incorporation of newly FDA-approved granulocyte-colony stimulating factor biosimilars for the prevention and treatment of FN.
We aim to investigate the incidence, patterns and timing of brain metastases in advanced breast cancer patients who have previously received trastuzumab. Eighty-seven patients who had received ...trastuzumab for advanced breast cancer from November 1999 to September 2003 at the Royal Marsden Hospital were assessed. With a median follow-up period of 11 months from commencing trastuzumab, 23 patients developed brain metastases (30% at 1 year; 95% CI 58-82%). Among 57 patients who had clinical benefits on trastuzumab, 12 (21%) patients developed first disease progression in brain with 75% of them had isolated CNS progression. Moreover, among patients who received trastuzumab as first line treatment, isolated brain metastases were the initial site of progression in 17% patients. Nearly all patients developed parenchymal brain disease. This study shows brain metastases are common phenomenon in HER2 positive advanced breast cancer patients receiving trastuzumab and also may implicate the brain as a sanctuary site for early relapse in this patient cohort.
Using data from the ACT1ON study, we conducted secondary analyses to assess the relationship between minutes of moderate-to-vigorous physical activity (MVPA) and glycemia in adults with type 1 ...diabetes (T1D) and overweight or obesity.
Participants (
= 66) with T1D provided measures of glycemia (hemoglobin A1c HbA1c, percent of time below range <70 mg/dL, time-in-range TIR 70-180 mg/dL, and time above range TAR >180 mg/dL) and self-reported physical activity (Global Physical Activity Questionnaire GPAQ and Previous Day Physical Activity Recalls PDPAR) at baseline, 3, 6, and 9 months postintervention. Wearable activity data were available for a subset of participants (
= 27). Associations were estimated using mixed effects regression models adjusted for design, demographic, clinical, and dietary covariates.
Among young adults 19-30 years of age with a baseline HbA1c of 7.9% ± 1.4% and body mass index of 30.3 (interquartile range 27.9, 33.8), greater habitual weekly MVPA minutes were associated with higher HbA1c through the GPAQ (
< 0.01) and wearable activity data (
= 0.01). We did not observe a significant association between habitual MVPA and any continuous glucose monitoring metrics. Using PDPAR data, however, we observed that greater daily MVPA minutes were associated with more TAR (
< 0.01) and reduced TIR (
< 0.01) on the day following reported physical activity.
Among young adults with T1D and overweight or obesity, increased MVPA was associated with worsened glycemia. As physical activity is vital to cardiovascular health and weight management, additional research is needed to determine how to best support young adults with T1D and overweight or obesity in their efforts to increase physical activity. Clinical Trial Registration number: NCT03651622.
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