Access to exercise referral schemes -- a population based analysis.

BACKGROUND: Sedentary behaviour is a public health priority in many countries. Hundreds of community-based exercise referral schemes have been established in Europe and USA, to increase physical activity. Experimental evidence questions the effectiveness of these schemes. No previous evaluations have considered a population approach nor provide detailed information on the types of people accessing these schemes. This is of concern given increasing health inequalities in other areas of care. Our register-based study quantified the numbers and characteristics of patients referred and accessing a district-wide exercise referral scheme. The analysis considers the effectiveness of these schemes to a geographically defined population. METHODS: Data were collected prospectively from a patient register for referrals made to a district-wide exercise referral scheme in north-west England. Analysis examined referral rates and the influence of practitioner and patient characteristics on access to the scheme. RESULTS: Over 5 years, 6,610 adults were referred from 125 general practices, with 60.8 per cent female and a mean age of 51.3 years (SD 12.6). This represents 4 per cent of the adult sedentary population in that district. The most common reason for referral was musculoskeletal or cardiovascular risk. Overall, 79 per cent attended at least the first appointment, with statistically significant predictors by age and reason for referral. Those referred for 'fitness' or 'mental health' were most likely to attend. Patients in the youngest and oldest age groups were least likely to attend. Patient's sex and deprivation and the number of patients referred by each general practice did not influence attendance. CONCLUSIONS: Primary-care patients seem to view the concept of exercise referral schemes positively but practitioners remain reluctant to refer many of their sedentary patients. There is doubt that exercise referral schemes like this will influence population levels of sedentary behaviour, when considered alongside their impact on physical activity in the longer term.

A comet assay of DNA damage and repair in K562 cells after photodynamic therapy using haematoporphyrin derivative, methylene blue and meso-tetrahydroxyphenylchlorin.

Single-cell electrophoresis (comet assay) has been used to evaluate DNA damage and repair in the human myeloid leukaemia cell line K562 after low-dose (predominantly sub-lethal) treatments of hyperthermia and photodynamic therapy (PDT). Three different photosensitizers were examined: haematoporphyrin derivative (HpD), methylene blue (MB) and meso-tetrahydroxyphenylchlorin (mTHPC). None of the drugs in the absence of light, nor in light alone, resulted in detectable DNA damage. However, a significant amount of DNA damage was detected immediately after treatment with haematoporphyrin derivative or methylene blue PDT compared with drug-only or light-only treatments; no residual level of DNA damage was evident for either drug following a 4-h post-treatment incubation at 37 degrees C. No significant DNA damage was detected after meso-tetrahydroxyphenylchlorin PDT or hyperthermia either immediately or 4 h after treatment. We conclude that the alkaline comet assay can be applied as an effective screening assay for DNA damage induced by a range of laser therapies.

Singlet oxygen and superoxide characteristics of a series of novel asymmetric photosensitizers.

The singlet oxygen quantum yields and superoxide quantum yields for a series of novel compounds based on an asymmetrical protoporphyrin molecule have been examined. Electron spin resonance was used to measure superoxide yield and time resolved luminescence for singlet oxygen. A comparison between these results and previously published cell survival data was carried out. A broad association was found between singlet oxygen quantum yield and clonogenic cell kill.

Factors influencing the outcome and duration of removable appliance treatment.

The study models and records of 150 consecutively completed removable appliance cases were analysed and the influence of various factors assessed on both the change in Peer Assessment Rating (PAR) score produced by treatment and the duration of treatment. For the purpose of analysis the material was divided into two groups; a functional appliance/headgear group (n = 43) and an upper removable appliance group (n = 103). The initial PAR score accounted for 71 per cent of the variation in PAR change in the functional/headgear group when combined with the sex of the patient; females on average showing a further improvement of 3 PAR points over equivalent males. The initial PAR score alone accounted for 68 per cent of the variation in PAR change in the upper removable appliance group. Sixty per cent of the variability in treatment duration could be explained in the functional/headgear group by the initial PAR score and a binary variable indicating whether three or more appliances had been required. Fifty-six per cent of the variability in duration in the upper removable appliance group was explained by the number of appliances used alone. Regression equations for prediction of outcome and duration of removable appliance treatment are given.

Understanding depression.

To understand the effects of depression on a patient's life, the physician must be aware how depression manifests itself. Somatic tension, strategies to relieve discomfort and social withdrawal must be recognized as symptoms of depression. An awareness of life situations which can give rise to these symptoms, as well as the effect of the physician's own reactions to the patient's depression, are helpful.