Can a brief behavioural change intervention encourage hospital patients with low physical activity levels to engage and initiate a change in physical activity behaviour?

BACKGROUND: Regular physical activity (PA) reduces risk factors for chronic disease. This novel study evaluates self-reported engagement with PA in recently discharged patients, identified as having low PA levels, who agreed to participate in an in-patient behaviour change intervention. METHOD: This exploratory study invited hospital in-patients, who were classified as 'moderately inactive' or 'inactive', to participate in a brief individual physiotherapy-led motivational interviewing (MI) behavioural change intervention. Patients were encouraged to set individual exercise and activity goals, and an appropriate programme referral was identified and agreed upon. RESULTS: Three hundred and forty-two of 526 patients, who were screened between January 2017 and March 2018, were classified 'inactive' or 'moderately inactive'. Seventy-seven percent of patients consented to participate in the brief MI intervention (n=58 'moderately active', n=206 'inactive'). One hundred percent participants who received the brief intervention agreed to attend a PA programme. At telephone follow-up, 66% self-reported engagement in community exercise or independent PA initiatives. CONCLUSION: This exploratory study demonstrates that a brief, MI-facilitated, behaviour change intervention is feasible and has the potential to aid PA engagement for hospital patients with low PA levels upon discharge from hospital. Considering that the 'first-step' with engagement in PA is often the biggest challenge for patients, this initiative has promise to improve PA behaviour and could be rolled out across the National Health Service (NHS).

Tip60 is a nuclear hormone receptor coactivator.

The androgen receptor (AR) is a member of the nuclear hormone receptor superfamily. Recent work in this field has been focused upon defining the mechanisms of transcriptional control exacted by members of this superfamily. Using a COOH-terminal region of the human AR in a yeast two-hybrid screen, we have identified Tip60 as an AR-interacting protein. In this report, we show that Tip60, which was originally identified as a coactivator for the human immunodeficiency virus TAT protein, can enhance AR-mediated transactivation in a ligand-dependent manner in LNCaP and COS-1 cell lines. In addition, our experiments show that Tip60 can also enhance transactivation through the estrogen receptor and progesterone receptor in a ligand-dependent manner; thus identifying Tip60 as a nuclear hormone receptor coactivator. Our studies also demonstrate that Tip60 co-immunoprecipitates with the full-length AR in vitro and that, in our system, Tip60 enhances transactivation to levels observed with the coactivators steroid receptor coactivator 1, p300, and CREB-binding protein. The importance of such proteins in enhancing nuclear hormone receptor-mediated transcriptional activation is widely accepted, and this work suggests that Tip60 may have an equally important role to play.

Androgen regulation of ornithine decarboxylase in human prostatic cells identified using differential display.

Androgens are essential for normal prostate physiology and have a permissive role in the development and progression of prostate cancer. Using the mRNA differential display technique, ornithine decarboxylase (ODC) was identified to be up-regulated by androgens in human prostatic LNCaP cells. On Northern analysis, the induction of ODC expression by 10 nM androgen was rapid and continued up to 48 h exposure with a maximum 6.3-fold up-regulation. The anti-androgen Casodex inhibited the androgen-induced up-regulation of ODC, whereas the protein synthesis inhibitor cycloheximide did not. Together these data suggest that regulation is mediated through the androgen receptor protein and does require secondary protein synthesis, respectively. The kinetics of induction of ODC were almost identical to those of prostate specific antigen. Taken together these data suggest that ODC is directly regulated by androgens in LNCaP cells.

Tissue reactions to biodegradable and non-degradable membranes placed transcutaneously in rats, observed longitudinally over a period of 4 weeks.

The aim of this study was to observe the tissue responses to a number of membrane materials processed for use in guided tissue regeneration at different time periods. Non-degradable Gore-Tex PTFE membrane and degradable polylactic acid (PLA) membranes were placed transcutaneously in surgical incisions made in the dorsum of rats. The tissue responses to these materials were observed histologically at 3 days, 1 week and 4 weeks after placement. A wide variation in the tissue responses to both materials was evident at each time period. These variations could not be attributed to different rates of healing over time, but rather to more complex factors. These factors may include differences in host responses between different animals, local factors pertaining to specific site variations, physical characteristics of the materials like surface texture, and contamination from the wound surface. Neither membrane material was found to be totally satisfactory. The PLA membranes were well tolerated by the tissues but they were unevenly absorbed within 2 weeks of placement. The Gore-Tex PTFE membranes, however, were associated with prolonged acute inflammatory infiltrate throughout the duration of the study, indicating that they were less well tolerated by the tissues than the PLA materials. As the healing characteristics of tissues are complex and highly variable, and as neither the non-degradable PTFE or degradable PLA membranes demonstrated ideal tissue responses, it is concluded that variations in clinical responses to these materials used in regeneration techniques must be anticipated.

A flow cytometric study of c-erbB-3 expression in breast cancer.

In order to assess the specificity of biotinylated anti-c-erbB-3 antibody, screening was performed on a series of tumour cell lines and lymphocytes. Staining was found to be consistent, with good reproducibility. Twenty-nine consecutive breast cancer samples were obtained from women treated with tamoxifen and undergoing elective mastectomy. Twenty-eight invasive ductal carcinomas and 1 DCIS were stained for c-erbB-3 expression: 2 were grade I (Bloom and Richardson), 15 grade II, and 11 grade III tumours, 1 being unclassified; 16 were axillary node positive and 10 node negative; in 2 cases no nodes were sampled. Tumours examined by flow cytometry were stained with cytokeratin FITC antibody and the cytokeratin-positive population gated. Using Mann-Whitney analysis no association was seen between c-erbB-3 expression and Bloom and Richardson grade or axillary node status. In the tumour samples c-erbB-3 expression was found to show as association with EGF-R (P = 0.021 r2 = 0.16), PgR (P = 0.02, r2 = 0.16), c-myc (P < 0.0001, r2 = 0.5), c-jun (P = 0.001, r2 = 0.4) and c-fos (P = 0.001, r2 = 0.5) but not with c-erbB-2 (P = 0.2, r2 = 0.06), ER (P = 0.4, r2 = 0.02) or p53 1801 (P = 0.05, r2 = 0.2). Expression of c-erbB-3 may not be an independent marker of prognosis, but it is associated with other markers of poor prognosis and early cellular events linked with aberrant growth and differentiation.

Relationship between clinical periodontal condition and the radiological appearance at 1st molar sites in adolescents. A 3-year study.

There has been considerable controversy about the incidence of periodontal disease in adolescents. It is noteworthy that there is disagreement between workers as to be radiological features that should be used to detect the earliest signs of periodontitis, and variation in the choice of criteria may have influenced the results of previous studies. The present project represents a 3-year longitudinal assessment into the periodontal condition, assessed clinically and radiologically, of a group of adolescents. The radiographic investigations were carried out using vertical bitewing radiographs and, to reduce potential error caused by variation in film placement and tube alignment, individual impressions were used so that the film could be positioned accurately at repeat assessments. It was found that several of the radiographic features, such as the width of the periodontal ligament space and the angle of the interproximal bone crest relative to the tooth, similar to those previously attributed to the commencement of destructive periodontal changes, were found to be correlated with the maturation changes associated with the eruption of the adjoining permanent teeth. In spite of the use of impressions, some of the series of radiographs showed variation in tube alignment, and several of the above radiological features were also found to correlate with errors in radiographic technique. It was concluded that the various eruptive and maturation changes taking place during this stage in the adolescent dentition must be allowed for when looking for the earliest signs of periodontal destruction.

The effect of systemic ibuprofen on gingival inflammation in humans.

This clinical trial investigated the influence of short-term ibuprofen therapy on the early phase of the treatment of adult chronic periodontitis. The subjects were 17 patients in good general health referred for specialist periodontal treatment, having moderate chronic adult periodontitis. A series of assessments were made every 2 weeks over an 8-week period, including evaluations of oral hygiene, gingival inflammation and probing pocket depths. All participants received oral hygiene instruction, and following baseline examinations, had half the dentition, chosen at random, treated by scaling and root planing. The patients were randomly distributed into 2 groups, a test group receiving a 14-day course of 800 mg ibuprofen daily, in 4 divided doses, and a control group who did not receive any drug regime. At the 2-week assessment following the drug regime, significantly greater reduction in gingival bleeding, colour and pocketing was detected in the test compared with the control group. The beneficial effects were less evident thereafter. Although clinical application of the regime used in this study would not be justified by these results, further research into anti-inflammatory agents as an adjunct in the treatment of periodontal diseases could be considered, in the light of the beneficial effect on gingivitis in the early phase of periodontal treatment reported.

A 4-year controlled clinical study into the use of a ceramic hydroxylapatite implant material for the treatment of periodontal bone defects.

10 patients with chronic adult periodontitis who had greater than 1 tooth with infra-bony pockets were treated at the test defects by periodontal flap procedures with implantation of hydroxylapatite particles; the control defects were treated by the same surgical procedures but without the implant. A total of 58 test defects and 59 control defects were treated. Each defect had measurements carried out at given sites on the involved tooth surfaces, the sites being considered for subsequent tabulation purposes under the category of shallow (less than 3 mm) moderate (3-6 mm) and deep (greater than 6 mm) initial pocket depths. There were 146 and 152 shallow sites, 216 and 241 moderate sites and 140 and 133 deep sites, at test and control sites, respectively. Measurements of recession, probing pocket depths and probing attachment levels were made at 6 months and 1, 2, 3 and 4 years. At all sites over the period of the study, for the moderate and deep initial pockets there was a significant reduction in probing depths and an increase in the probing attachment levels. At the 4th year of assessment for the initially deep pockets, the reduction in probing depths was significantly greater for the sites treated with the implant material. In view of the difficult clinical problem posed by the treatment of teeth with deeper periodontal bone defects, further research using either this type of implant material or similar material should be considered.

Histological evaluation of biodegradable and non-degradable membranes placed transcutaneously in rats.

The aim of this study was to assess histologically the response to membrane materials that might be used for guided tissue regeneration procedures, using a transcutaneous model on the dorsal surface of the rat. The materials included expanded polytetrafluoroethylene (PTFE) membrane (Gore-Tex), PTFE Millipore filter, biodegradable polylactic acid (PLA) and polyhydroxybutyrate/polyhydroxyvalerate copolymer membranes. 70 implants were placed in 10 rats under general anaesthesia. At 2 weeks after the operative procedure, the specimens were assessed histologically for the composition of the tissue surrounding the material, the types of cell in the infiltrate and the degree of absorption particularly in the superficial tissues. PTFE was associated with greater epithelial downgrowth and a mainly polymorphonuclear infiltrate. PLA showed a high incidence of absorption, with a mainly monocytic infiltrate. Considerable variation was found between these extremes. It was concluded that the healing responses associated with the membranes were complex and varied, and further work is required to establish the factors which govern the variation in the healing response. The findings are of relevance to regenerative procedures which rely on the guiding influence of artificial membranes on the healing tissues. The PLA material was well tolerated and was gradually absorbed. Further research may enable this material to form the basis of a one stage guided tissue regeneration procedure.

Computerized densitometric analysis of interproximal bone levels in a controlled clinical study into the treatment of periodontal bone defects with ceramic hydroxyapatite implant material.

The aim of this controlled clinical study was to utilize computer-assisted densitometric analysis of radiographs to assess the effectiveness of treating periodontal osseous defects with a sintered hydroxyapatite implant material. It was found that over the 2-year period of the study for the osseous defects treated by the implant material, there was a gain in the height of the hard tissue relative to the cemento-enamel junction; this gain was statistically significant compared with the results for the control sites.

A comparison between measurements made with a conventional periodontal pocket probe, an electronic pressure probe and measurements made at surgery.

This study compared clinical measurements using a manual periodontal probe and an electronic pressure probe using a 0.25 N force, and related them to measurement of the bone levels at the time of surgery. All measurements were taken from the cemento-enamel junction at specified sites. It was found that neither probing technique provided a means for accurately measuring bone level. In the presence of healed tissue, little difference was found between the two instruments; whereas the manual probe more closely approximated the actual level of bone in the presence of inflammation. It was therefore concluded that under the conditions of present study the manual probe depth measurements were the more applicable for routine clinical use.

Histological investigation of the tissue response to hydroxyapatite used as an implant material in periodontal treatment.

Patients with severe periodontitis and who had one or more teeth with infrabony pockets were treated by periodontal surgery with implantation of hydroxyapatite particles into the bone defects at the time of surgery. Subsequently, in three patients it was found necessary to extract a tooth for reasons not related to the previous periodontal treatment. Specimens that included the local soft tissues and crestal bone attached to the teeth were obtained at 22, 40 and 80 weeks after placement of the implant. They were decalcified and stained with haematoxylin and eosin and examined under light microscopy. The healing response was found to vary between specimens, and between sites within the same specimen. The early stage of healing showed the implant particles surrounded by collagen. Subsequently, varying degrees of resorption of the periphery of the particles was seen, and at some sites bone deposition was observed. These different healing responses were found to be progressing concurrently at sites in close proximity. Further work is needed to confirm the histological findings described in the paper.

A microcomputer system for the analysis of dental radiographs.

A system for the digital storage and computer analysis of dental radiographs is described. The system is based on popular microcomputer, of a type commonly used for other purposes in general dental practice. The analysis system includes methods to compensate for variations due to exposure and development in serial radiographs. Interactive software allows a detailed analysis of the radiograph, producing qualitative and quantitative data for diagnosis and monitoring. An example of its application is given.

The relationship between the multidimensional health locus of control and the performance of subjects on a preventive periodontal programme.

Criteria have been defined to quantify a personality characteristic-termed locus of control. The criterion at one extreme of this range was referred to as external, indicating a belief that health was determined by a variety of other factors such as powerful other individuals or by chance. The criterion at the other extreme was termed internal, indicating a belief that health might be modified by the behaviour pattern of the individual. Locus of control scales have been used to relate psychological factors to physical disease, and the response of patients to disease. The aim of the present study was to investigate whether locus of control could be used to anticipate the response of subjects to a plaque control programme. A study was carried out on 14 males and 46 females to investigate the relationship between the multidimensional health locus of control (MHLC) and the response of a group of office workers to a plaque control programme. It was found that there was significant correlation between the external MHLC dimension of powerful others and improvement in some of the clinical criteria; a similar result was found for the internal dimension of the MHLC. In contrast, there was minimal correlation between the external dimension of the MHLC termed chance and the clinical results. It was concluded that subjects who perceive their susceptibility to disease being influenced by powerful external factors or who believe that susceptibility can be controlled by their own actions, respond more positively to a plaque control regime than those subjects who consider that susceptibility to disease is an event of chance.