Factors associated with older patients' engagement in exercise after hospital discharge

Hill A-M, Hoffmann T, McPhail S, Beer C, Hill KD, Brauer SG, Haines TP. Factors associated with older patients' engagement in exercise after hospital discharge.

Objectives

To identify factors that are associated with older patients' engagement in exercise in the 6 months after hospital discharge.

Design

A prospective observational study using qualitative and quantitative evaluation.

Setting

Follow-up of hospital patients in their home setting after discharge from a metropolitan general hospital.

Participants

Participants (N=343) were older patients (mean age ± SD, 79.4±8.5y) discharged from medical, surgical, and rehabilitation wards and followed up for 6 months after discharge.

Interventions

Not applicable.

Main Outcome Measures

Self-perceived awareness and risk of falls measured at discharge with a survey that addressed elements of the Health Belief Model. Engagement and self-reported barriers to engagement in exercise measured at 6 months after discharge using a telephone survey.

Results

Six months after discharge, 305 participants remained in the study, of whom 109 (35.7%) were engaging in a structured exercise program. Multivariable logistic regression analysis demonstrated participants were more likely to be engaging in exercise if they perceived they were at risk of serious injury from a fall (odds ratio [OR] =.61; 95% confidence interval [CI], .48–.78; P<.001), if exercise was recommended by the hospital physiotherapist (OR=1.93; 95% CI, 1.03–3.59; P=.04), and if they lived with a partner (OR=1.97; 95% CI, 1.18–3.28; P=.009). Barriers to exercise identified by 168 participants (55%) included low self-efficacy, low motivation, medical problems such as pain, and impediments to program delivery.

Conclusions

Older patients have low levels of engagement in exercise after hospital discharge. Researchers should design exercise programs that address identified barriers and facilitators, and provide education to enhance motivation and self-efficacy to exercise in this population.     

Neurocognitive Impact of Antiretroviral Treatment: Thinking Long-Term

Combination antiretroviral therapy has significantly reduced morbidity and mortality with HIV infection. However, HIV-associated neurocognitive disorders persist at a relatively high prevalence rate despite successful systemic treatment. This paper reviews the current issues related to the neurocognitive impact of antiretroviral treatment.     

Non-invasive in vivo imaging of vessel calibre in orthotopic prostate tumour xenografts

Susceptibility contrast magnetic resonance imaging (MRI), utilising ultrasmall superparamagnetic iron oxide (USPIO) particles, was evaluated for the quantitation of vessel size index (Rv, μm), a weighted average measure of tumour blood vessel calibre, and fractional tumour blood volume (fBV, %), in orthotopically propagated murine PC3 prostate tumour xenografts. Tumour vascular architecture was assessed in vivo by MRI prior to and 24 hr after treatment with 200 mg/kg of the vascular disrupting agent ZD6126. A Bayesian hierarchical model (BHM) was used to reduce the uncertainty associated with quantitation of Rv and fBV. Quantitative histological analyses of the uptake of Hoechst 33342 for perfused vasculature, and haematoxylin and eosin staining for necrosis, were also performed to qualify the MRI data. A relatively large median Rv of 40.3 μm (90% confidence interval (CI90) = 37.4, 44.0 μm) and a high fBV of 5.4% (CI90 = 5.3, 5.5%) were determined in control tumours, which agreed with histologically determined vessel size index. Treatment with ZD6126 significantly (p < 0.01) reduced tumour Rv (34.2 μm, CI90 = 31.2, 38.0 μm) and fBV (3.9%, CI90 = 3.8, 4.1%), which were validated against histologically determined significant reductions in perfusion and vessel size, and increased necrosis. Together these data (i) highlight the use of a BHM to optimise the inferential power available from susceptibility contrast MRI data, (ii) provide strong evaluation and qualification of R(v) and fBV as non-invasive imaging biomarkers of tumour vascular morphology, (iii) reveal the presence of a different vascular phenotype and (iv) demonstrate that ZD6126 exhibits good anti-vascular activity against orthotopic prostate tumours.     

Effects of dexpanthenol with or without Aloe vera extract on radiation-induced oral mucositis: Preclinical studies

Purpose: To define the effect of dexpanthenol with or without Aloe vera extract on radiation-induced oral mucositis.

Materials and methods: Mouse tongue mucosal ulceration was analysed as the clinically relevant endpoint. Graded single or fractionated dose irradiation (10 x 3?Gy/2 weeks, graded test doses on day 14) were combined with topical administration of dexpanthenol or a base, with or without Aloe vera extract. The formulations were applied for 14 days (single dose) or 24 days after the first fraction.

Results: Single dose irradiation resulted in an ED₅₀ (dose at which a positive mucosal response was expected in 50% of the animals irradiated) of 11.9?±?1.2?Gy. None of the formulations yielded a significant change in incidence or time course of ulceration. Test irradiation after 10 x 3?Gy gave an ED₅₀ of 9.0?±?0.1?Gy. Base treatment increased the ED₅₀-values to 10.5?±?0.8?Gy (p?=?0.0095) and 9.9?±?0.7?Gy (p?=?0.0445) without or with Aloe vera. Dexpanthenol resulted in ED₅₀ values of 9.5?±?0.1?Gy without Aloe vera (p?>?0.05), and of 10.9?±?0.9?Gy (p?=?0.0035) with Aloe vera. The latent time to ulceration was prolonged, compared to the control (6.3 days) without Aloe vera (8.0?–?8.2 days, p?<?0.001) and with dexpanthenol and Aloe vera (7.3 days, p?=?0.0239).

Conclusions: With single dose irradiation, neither dexpanthenol nor Aloe vera extract significantly changed the oral mucosal radiation response. With fractionated irradiation, drug administration significantly increased the isoeffective radiation doses, independent of dexpanthenol or Aloe vera content. Neither dexpanthenol nor Aloe vera display a prophylactic potential.     

Emergency presentation of cancer and short-term mortality

Background:

The short-term survival following a cancer diagnosis in England is lower than that in comparable countries, with the difference in excess mortality primarily occurring in the months immediately after diagnosis. We assess the impact of emergency presentation (EP) on the excess mortality in England over the course of the year following diagnosis.

Methods:

All colorectal and cervical cancers presenting in England and all breast, lung, and prostate cancers in the East of England in 2006–2008 are included. The variation in the likelihood of EP with age, stage, sex, co-morbidity, and income deprivation is modelled. The excess mortality over 0–1, 1–3, 3–6, and 6–12 months after diagnosis and its dependence on these case-mix factors and presentation route is then examined.

Results:

More advanced stage and older age are predictive of EP, as to a lesser extent are co-morbidity, higher income deprivation, and female sex. In the first month after diagnosis, we observe case-mix-adjusted excess mortality rate ratios of 7.5 (cervical), 5.9 (colorectal), 11.7 (breast ), 4.0 (lung), and 20.8 (prostate) for EP compared with non-EP.

Conclusion:

Individuals who present as an emergency experience high short-term mortality in all cancer types examined compared with non-EPs. This is partly a case-mix effect but EP remains predictive of short-term mortality even when age, stage, and co-morbidity are accounted for.     

A multisite evaluation of summer camps for children with cancer and their siblings

ABSTRACT

Summer camps for pediatric cancer patients and their families are ubiquitous. However, there is relatively little research, particularly studies including more than one camp, documenting outcomes associated with children's participation in summer camp. The current cross-sectional study used a standardized measure to examine the role of demographic, illness, and camp factors in predicting children's oncology camp-related outcomes. In total, 2,114 children at 19 camps participated. Campers were asked to complete the pediatric camp outcome measure, which assesses camp-specific self-esteem, emotional, physical, and social functioning. Campers reported high levels of emotional, physical, social, and self-esteem functioning. There were differences in functioning based on demographic and illness characteristics, including gender, whether campers/siblings were on or off active cancer treatment, age, and number of prior years attending camp. Results indicated that summer camps can be beneficial for pediatric oncology patients and their siblings, regardless of demographic factors (e.g., gender, treatment status) and camp factors (e.g., whether camp sessions included patients only, siblings only, or both). Future work could advance the oncology summer camp literature by examining other outcomes linked to summer camp attendance, using longitudinal designs, and including comparison groups.     

The association between race and prostate cancer risk on initial biopsy in an equal access,multiethnic cohort

Purpose

Population-based studies have established a link between race and prostate cancer (PC) risk, but whether race predicts PC after adjusting for clinical characteristics is unclear. We investigated the association between race and risk of low- and high-grade PC in men undergoing initial prostate biopsy in an equal access medical center.

Methods

We conducted a retrospective record review of 887 men (48.6 % black, 51.4 % white) from the Durham Veterans Affairs Medical Center who underwent initial prostate biopsy between 2001 and 2009. Multivariable logistic regression analysis of race and biopsy outcome was conducted adjusting for age, body mass index, number of cores taken, prostate-specific antigen (PSA), and digital rectal examination findings. Multinomial logistic regression was used to test the association between black race and PC grade (Gleason <7 vs. ≥7).

Results

Black men were younger at biopsy (61 vs. 65 years, p < 0.001) and had a higher pre-biopsy PSA (6.6 vs. 5.8 ng/ml, p = 0.001). A total of 499 men had PC on biopsy (245 low grade; 254 high grade). In multivariable analyses, black race was significantly predictive of PC overall [odds ratio 1.50, p = 0.006] and high-grade PC [relative risk ratio (RRR) 1.84, p = 0.001], but was not significantly associated with low-grade PC (RRR 1.29, p = 0.139).

Conclusion

In an equal access healthcare facility, black race was associated with greater risk of PC detection on initial biopsy and of high-grade PC after adjusting for clinical characteristics. Additional investigation of mechanisms linking black race and PC risk and PC aggressiveness is needed.