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).

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.

A comparison of postsurgical healing following debridement by ultrasonic or hand instruments.

Subjects for the study were 15 patients requiring periodontal surgery in the maxillary posterior quadrants. A split mouth technique with assignment of quadrants by random alternation was used. Assessments were carried out at given time intervals using the Gingival Index, crevicular fluid measurement, Plaque Index and Retention Index. Pain experience following surgery was also noted. Approximately 8 weeks after the initial assessment, periodontal flap surgery was carried out. On the one side debridement was carried out using an ultrasonic scaler, on the other side, hand instrumentation only was used. On the side receiving ultrasonic debridement during surgery, there was an increased rate of healing as measured by the Gingival Index and crevicular fluid. There was no difference in postoperative pain experience, Plaque Index or Retention Index.

Effects of tobacco smoking on plaque development and gingivitis.

A study was undertaken to test the hypothesis that patients who smoke tobacco have a more rapid rate of plaque deposition and development of gingivitis than those patients who do not smoke tobacco. Twenty subjects participated in this study, their age range was 17 to 30 years. Ten were smokers and 10 were nonsmokers. After an initial thorough removal of all deposits, oral hygiene measures were stopped for 10 days. On days 3, 7 and 10, plaque levels were evaluated using the Plaque Index and the gingival status was evaluated using the Gingival Index. Samples of plaque were stained by the Gram technique and examined microscopically. Plaque levels appeared to be higher in smokers than nonsmokers but the differences were not statistically significant. No consistent differences were evident in the gingival status of the two groups. Microbiological analysis showed a statistically significant increase in the percentage of Gram-positive bacteria to Gram-negative bacteria in the smokers as compared to the nonsmokers on day 3, however these differences were not maintained in the plaque samples taken after the 3rd day.

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.

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.

A comparison between conventional gingivectomy and a non-surgical regime in the treatment of periodontitis.

The treatment of periodontitis by scaling and oral hygiene instruction was compared with the same regime augmented by conventional gingivectomy. The procedures were allocated randomly to contralateral sides of the maxillary arches of 28 patients. Following both regimes there was significant reduction in Plaque Index, Gingival Index, crevicular fluid and depths of pockets. There was slight gain in attachment on the non-surgical sides, and a minor loss of attachment on the surgical sides. Comparing the two regimes, over the second half of the study there was no significant difference in Plaque Index or crevicular fluid; however, on the surgical sides there was significantly greater reduction in Gingival Index and depths of pockets. Residual pockets after either technique were associated with more inflammation than where sulcus depths were less than 2 mm. Retrospective comparisons of the initial depths of pockets with the final gingival status indicated that, when initial depths of pockets had been 3 mm or over, surgical treatment was more effective than non-surgical in reducing the final values of both depths of pockets and inflammation; this finding was statistically significant for some, but not all of the parameters. Treatment of shallow pockets by either technique was more effective than the treatment of deep pockets. Final Plaque Index values of zero were associated with significantly less inflammation and pocketing than where plaque deposits could be detected.

The present status of the gingivectomy procedure.

The use of the conventional gingivectomy procedure is indicated to achieve optimum gingival contour and to eliminate supra-alveolar pockets where these do not extend beyond the muco-gingival junction. The instrument of choice for the procedure is a gingivectomy knife. Where a blood-free field is required, electrosurgery may be used provided the instrument is not brought into contact with bone. The maintenance of good oral hygiene is essential.

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.

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.

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.