Factors influencing patient uptake of an exercise referral scheme: a qualitative study.

Exercise referral schemes aim to increase physical activity amongst inactive individuals with or at risk of long-term health conditions. Yet many patients referred to these schemes (by health professionals) fail to take up the exercise opportunities on offer. Understanding factors influencing uptake to exercise referral schemes may help improve future attendance. Using the Socio-Ecological Model as a framework, this qualitative study aimed to explore factors influencing uptake to an exercise referral scheme based in the North West of England. Semi-structured interviews were conducted with referred patients (n = 38) about their reasons for referral, interactions with referring health professionals, events following referral and ideas to improve future uptake. Data were analysed thematically and mapped onto the constructs of the Socio-Ecological Model. Factors reported to influence uptake included intrapersonal (past PA experiences, motivation, competing priorities), interpersonal (scheme explanations, support) and organizational influences (scheme promotion, communication between service, cost). Whilst several intrapersonal-level factors influenced patient decisions to uptake the exercise referral scheme, modifiable interpersonal and organizational factors were identified as potential targets for intervention. Recommendations are made for improving awareness of exercise referral schemes and for enhancing communication between referring practitioners, patients and referral scheme staff.

A retrospective 15-year review: survival advantage after switching to sirolimus in hepatitis C virus infected liver graft recipients.

BACKGROUND: The use of sirolimus-based immune suppression in liver transplantation, particularly in hepatitis C virus (HCV)-infected recipients, remains contentious. There is some evidence that sirolimus retards hepatic fibrosis, is renal sparing and may be of benefit in preventing hepatocellular carcinoma (HCC) recurrence. Sirolimus has not been adopted by many transplant centres because of persistent concerns regarding an increased risk of hepatic artery thrombosis, graft loss and death with de novo sirolimus. AIM: To review the impact of switching to sirolimus monotherapy in HCV-infected liver recipients with respect to survival, graft loss and hepatic fibrosis. METHODS: A retrospective review of 190 patients from a single centre undergoing first liver transplantation for HCV over 15 years. 113 patients were switched from calcineurin inhibitor (CNI)-based therapy to low-dose sirolimus monotherapy at a median of 15 months after transplantation for HCV-related fibrosis (72%), renal impairment (14%) or high-risk HCC (5%). RESULTS: Patients switched to sirolimus had improved survival (P < 0.001) and slower progression to cirrhosis (P = 0.001). In patients with HCC (n = 91), sirolimus duration rather than strategy was an independent predictor of survival (P = 0.001) and extended time to HCC recurrence (33 vs. 16 months). Patients switched for renal dysfunction showed improvement in serum creatinine (140-108 µmol/L, P = 0.001). Those remaining on CNI-therapy were more likely to develop post-transplant diabetes (P = 0.03). CONCLUSION: These data suggest selective switching to low-dose sirolimus monotherapy in HCV-positive liver recipients improves clinical outcome.

Second-hand smoke levels in UK pubs and bars: do the English Public Health White Paper proposals go far enough?

BACKGROUND: The English Public Health White Paper proposes introducing smoke-free workplaces except in pubs and bars that do not prepare and serve food. The bar area will be non-smoking in exempted pubs. OBJECTIVE: To explore the likely impact of these proposals in UK pubs and bars. METHODS: A total of 59 pubs and bars within Greater Manchester in 2001 were chosen. Thirteen were mechanically ventilated, 12 were naturally ventilated and 34 had extractor fans; 23 provided non-smoking areas. We measured time-weighted average concentrations of respirable suspended particles (RSP), solanesol tobacco-specific particles and vapour-phase nicotine (VPN) over a 4-h sampling period on a Tuesday or Saturday night. RESULTS: Second-hand smoke (SHS) levels in smoking areas were high (mean RSP 114.5 microg/m3, VPN 88.2 microg/m3, solanesol 101.7 microg/m3). There were only small (5-13 per cent) reductions in bar areas. Mean levels were lower in non-smoking areas: by 33 per cent for RSPs, 52 per cent for solanesol particles and 69 per cent for VPN. Compared with other settings (homes and other workplaces) with unrestricted smoking, mean SHS levels were high throughout all areas of the pubs regardless of ventilation strategy. CONCLUSION: Partial measures, like those in the English Public Health White Paper, will leave bar staff in exempted pubs unprotected from the occupational hazard of SHS.

Liver transplantation for hepatitis C virus related liver disease.

Liver transplantation is a useful treatment for end stage liver disease of all aetiologies but recurrent disease presents an ongoing challenge, particularly for hepatitis C virus (HCV) where recurrence is almost universal. Immunosuppression is needed for all patients after transplantation and should be tailored to the individual patient, with particular problems being noted for those with HCV. The longer term effects of immunosuppression, particularly renal failure and the adverse effects of certain treatments on the liver graft, have become more important as survival improves and results are studied for longer periods after transplantation.

Endotoxin exposure in asthmatic children and matched healthy controls: results of IPEADAM study.

UNLABELLED: Children spend increasing time indoors. Exposure to environmental factors may contribute to the development or exacerbation of the asthmatic phenotype. Inter-relationships between these factors might influence the manifestation of asthma. Endotoxin exposure has been shown to have pro-inflammatory and protective effects in different situations. We investigated the exposure to several indoor pollutants (endotoxin, Der p 1, damp, ETS, PM2.5) in asthmatic and healthy children. The children were recruited from two primary care centers according to their response to a validated questionnaire. Asthmatic children were matched for sex, age and sib-ship size with children living in asthma free households. Of 90 matched pairs, higher levels of endotoxin were found in the living room carpets, but not the bedroom carpet or mattresses of the asthma compared with the control homes (STATA analysis OR: 1.88 (1.11-3.18); P=0.018). Asthmatic children were also more likely to live as part of a single parent family, in a house where the parents self-reported the presence of damp, and where the living room had been redecorated in the 12 months prior to the sampling visits. This study suggests that endotoxin in urban homes is a risk factor for the development of asthma. Moreover, this study found that there were no statistically significant interactions between environmental factors. PRACTICAL IMPLICATIONS: This study has demonstrated that the home environments of English children (4-17) with asthma and without the disease do not differ greatly. With the exception of endotoxin, the parameters examined in this study, including house dust mite allergens, nitrogen dioxide, ETS and damp are unlikely to be related to the development of asthma. Avoidance of these pollutants may not be beneficial in preventing asthma in this age group.

Cost analysis of breath test versus endoscopy for dyspepsia.

BACKGROUND: There is currently much debate on the best way to manage dyspepsia in the community and cost effectiveness is often discussed. We aim to perform a cost analysis of a test and treat strategy for Helicobacter pylori versus endoscopy using data based on the breath test service in Leicester. METHODS: Retrospective analysis of data acquired over the 1-year period from March 1, 1999, to February 29, 2000, in a university teaching hospital. The main outcome measure was the cost of each management strategy. RESULTS: Referral to the breath test service cost pound 84.67 per person with dyspepsia (including treatment of positive patients and endoscopy cost of patients endoscoped). If the breath test service had not existed, referral for endoscopy would have cost pound 98.35 per person. This equates to a cost saving of pound 8,276 over the year studied for the 605 patients referred. It also resulted in 353 fewer endoscopies being performed. CONCLUSION: Direct referral to a H. pylori breath test service saves money, avoids an unpleasant test for many people and reduces the endoscopy waiting list.

Conservative management of a transdiaphragmatic fistula.

Case reports of transdiaphragmatic fistulas connecting subphrenic collections and empyemas are uncommon. We report the rare complication of a fistulous connection between a subphrenic collection and the bronchial tree.

A study of colo-rectal carcinoma in the Asian and European populations in the city of Leicester from 1981 to 1991.

For many years clinical reports have suggested that colo-rectal cancer is uncommon in the Asian population resident in England and a report in 1990 confirmed this in Asians living in Bradford. This study aims to establish the incidence of colo-rectal cancer in the Asian population resident in the city of Leicester during the 11 y period 1 January 1981-31 December 1991. The relative frequency of colo-rectal carcinoma in Asians compared to Europeans over the period studied was 0.16 (Asian/European, 95% confidence interval (CI) 0.04-0.75). This difference was statistically significant and further analysis showed that there was a real trend with an increased relative frequency amongst the younger age groups. Although there was a significantly lower incidence of colo-rectal carcinoma in the Asian population in Leicester city over the period studied it is unknown whether this is due to environmental or genetic factors. During the next decade it is likely to become clearer as to whether this difference will persist or whether there will be an increase in the incidence of colo-rectal carcinoma in Asians in Leicestershire.

Commuter exposure to respirable particles inside buses and by bicycle.

The exposure of bus commuters and a cyclist to respirable particles in the city of Manchester has been evaluated, using personal sampling pumps installed in the cabs of the vehicles and carried by the cyclist. These have provided an estimate of the average exposure of commuters using bus services and cycling in a congested European city.