Emerging and traditional 5-α reductase inhibitors and androgen receptor antagonists for male androgenetic alopecia.

INTRODUCTION: Androgenetic alopecia (AGA) is the most prevalent cause of male hair loss, often requiring medical and/or surgical intervention. The US FDA has approved topical minoxidil and oral finasteride for male AGA treatment. However, some AGA patients fail to respond satisfactorily to these FDA-approved treatments and/or may experience side effects, based on their individual profiles. To mitigate the shortcomings of these treatments, researchers are now exploring alternative treatments such as newer 5-α reductase inhibitors (5-ARIs) and androgen receptor antagonists (ARAs). AREAS COVERED: This article reviews the safety and effectiveness of well-known 5-α reductase inhibitors (5-ARIs) like finasteride and dutasteride, as well as the newer 5-ARIs, emerging androgen receptor antagonists (ARAs), and natural products such as saw palmetto and pumpkin seed oil in the treatment of male AGA. EXPERT OPINION: Although several newer 5-ARIs, ARAs, and natural products have exhibited promise in clinical trials, additional research is essential to confirm their safety and efficacy in treating male AGA. Until additional evidence is available for these agents, the preferred treatment choices for male AGA are the FDA-approved treatments, topical minoxidil, and oral finasteride.

Identifying indicators for the evaluation of community interventions and initiatives in a multi-site public health programme.

INTRODUCTION: Measuring success of community-level programmes and interventions is important, and indicators can provide valuable information to achieve this. However, identifying appropriate indicators can be challenging. Indicators can be identified by official local stakeholders such as local authorities, but involving communities can add value and trust to the project, with community involvement likely to improve programme sustainability. METHODS: As part of the evaluation of multi-site community initiatives, we used local health profiles to identify core indicators that overlapped sites. In addition, we engaged with members of the community during a pilot data collection training day to identify issues they identified as important for measuring health and well-being locally. RESULTS: A total of 313 indicators were identified from local profiles, with 31 indicators meeting inclusion criteria. The community identified 26 issues, collated into eight categories, only three of which were identified in core indicators. Tools were sourced or created for the other community-identified categories. DISCUSSION: The methodology identified validated indicators comparable across all sites, based on local health profiles. It also identified tools for measuring issues identified by members of the community. The exercise demonstrated disconnect between priorities of official bodies, researchers and communities, indicating multiple approaches should be considered when evaluating community initiatives.

Association between alcohol use and frailty among elder adults in three Chinese cities.

BACKGROUND: Frailty is often described as a condition of the elderly and alcohol use is associated with frailty. The aim of this study is to examine the associations between alcohol use and frailty in three cities in elder adults. METHODS: A cross-sectional study was conducted in three cities in China from June 2017 to October 2018. In total, 2888 residents aged ≥65 years old were selected by using a multi-level stage sampling procedure. Alcohol use was assessed by Focusing on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers (CAGE) four-item questionnaire. Frailty was measured by a validated Chinese version of the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale. Multinomial logistic regressions were used to examine the association of alcohol use with pre-frailty and frailty after controlling for varied covariates. RESULTS: In general, the prevalence of pre-frailty and frailty was 38.64 and 20.26%, respectively. After controlling for covariates and interaction of age and problematic drinking, non-problematic drinkers neither had association with pre-frailty (OR: 1.15, 95%CI:0.86-1.52) nor with frailty (OR:0.90, 95%CI:0.60-1.36), and problematic drinkers neither had association with frailty (OR: 1.21, 95%CI:0.83-1.76), while problematic drinkers had high odd ratios of frailty (OR:3.28, 95%CI:2.02-5.33) compared with zero-drinker. CONCLUSIONS: Our study found a positive association between problematic drinking and frailty, no relationship between non-problematic drinking and (pre-)frailty compared with zero-drinking among Chinese elder adults. Based on previous findings and ours, we conclude it is important for the prevention of frailty to advocate no problematic drinking among elder adults.

An evaluation of the Birchwood Junk Food Café, Skelmersdale.

Food waste is an issue of global concern requiring worldwide action. In the UK, £19 billion worth of food is wasted every year. A variety of initiatives have been developed to redistribute surplus food to those in need. The Birchwood Junk Food Café in Skelmersdale combines the reduction of food waste with community and societal benefits. The University of Manchester and the Birchwood Centre conducted an evaluation of the café including a customer satisfaction survey, a long-form health and wellbeing survey and qualitative interviews. Each day the café produces a three-course menu for the public on a 'pay-as-you-feel' basis. During an 18-month period, the café intercepted 32 729 kg of food that would otherwise have gone to waste, served over 1500 people, with 3500 covers, 60 different dishes and 1200 volunteer hours. Customer satisfaction was extremely high with 88% being repeated visitors and 86% rating the café as excellent. Volunteers include youth from the local Birchwood Centre, who gain valuable experiences. Customers benefit from social interactions and additional community cohesion. The café offers an unique opportunity to impact on the wider community and provides support and structure for the volunteers.

The impact of education level on Knowledge, Attitudes and Practices towards COVID-19 in Edo State, Nigeria.

BACKGROUND: For effective Public Health measures, factors that influence Knowledge, Attitudes and Practices (KAP) need to be understood. In this paper, we document the relationship between levels of education on the KAP towards COVID-19 among the population of Edo State, Nigeria. METHODS: A cross-sectional KAP questionnaire was delivered across 13 communities. The study population was dichotomized into those who had or had not completed secondary education. Chi-square tests were conducted to determine statistical significance. RESULTS: Of the 538 participants, 30% had completed secondary education. Those with secondary education were significantly more likely to recognize symptoms of COVID-19 (P < 0.001). For attitudes, only one option showed a statistically significant association with 78.4% of those who did not complete secondary education having a high confidence in the church compared with 66% of those who had (P = 0.022). For practices, those who have completed secondary education practiced all of the supplied measures more than those who had not, except for taking herbal supplements. DISCUSSION: Higher levels of education impacts on knowledge and practices but has less impact on attitudes regarding how well certain individuals/organizations can handle the pandemic. Findings highlighted the importance of tailoring public health communication and strategies to local populations to improve the efficacy.

Less is more in the difficult gallbladder: recent evolution of subtotal cholecystectomy in a single HPB unit.

INTRODUCTION: Subtotal cholecystectomy (SC) is a technique to manage the difficult gallbladder and avoid hazardous dissection and biliary injury. Until recently it was used infrequently. However, because of reduced exposure to open total cholecystectomy in resident training, we recently adopted subtotal cholecystectomy as the bail-out procedure of choice for resident teaching. This study reports our experience and outcomes with subtotal cholecystectomy in the years immediately preceding adoption and since adoption. METHODS: A retrospective analysis was conducted of patients undergoing SC from July 2010 to June 2019. Outcomes, including bile leak, reoperation and need for additional procedures, were analyzed. Complications were graded by the Modified Accordion Grading Scale (MAGS). RESULTS: 1571 cholecystectomies were performed of which 71 were SC. Subtotal cholecystectomy patients had several indicators of difficulty including prior attempted cholecystectomy and previous cholecystostomy tube insertion. The most common indication for SC was marked inflammation in the hepatocystic triangle (51%). As our experience increased, fewer patients required open conversion to accomplish SC and SC was completed laparoscopically, usually subtotal fenestrating cholecystectomy (SFC). Most patients (85%) had a drain placed and 28% were discharged with a drain. The highest MAGS complication observed was grade 3 (11 patients, 15%). Six patients had a bile leak from the cystic duct resolved by ERCP. At mean follow-up of about 1 year no patient returned with recurrent symptoms. CONCLUSIONS: Subtotal fenestrating cholecystectomy is a useful technique to avoid biliary injury in the difficult gallbladder and can be performed with very satisfactory rates of bile fistula, ERCP, and reoperation.

Longitudinal association between physical activity and health-related quality of life among community-dwelling older adults: a longitudinal study of Urban Health Centres Europe (UHCE).

BACKGROUND: Physical activity (PA) may play a key role in healthy aging and thus in promoting health-related quality of life (HRQoL). However, longitudinal studies on the association between PA and HRQoL are still scarce and have shown inconsistent results. In this study, we aimed to examine the longitudinal association between frequency of moderate PA and physical and mental HRQoL. Secondly, to assess the association between a 12-month change in frequency of moderate PA and HRQoL. METHODS: A 12-month longitudinal study was conducted in Spain, Greece, Croatia, the Netherlands, and the United Kingdom with 1614 participants (61.0% female; mean age = 79.8; SD = 5.2) included in the analyses. Two categories of the self-reported frequency of moderate PA including 1) 'regular frequency' and 2) 'low frequency' were classified, and four categories of the change in frequency of moderate PA between baseline and follow-up including 1) 'continued regular frequency', 2) 'decreased frequency', 3) 'continued low frequency' and 4) 'increased frequency' were identified. Physical and mental HRQoL were assessed by the 12-Item Short-Form Health Survey (SF-12). RESULTS: The frequency of moderate PA at baseline was positively associated with HRQoL at follow-up. Participants with a continued regular frequency had the highest HRQoL at baseline and follow-up. Participants who increased the frequency of moderate PA from low to regular had better physical and mental HRQoL at follow-up than themselves at baseline. After controlling for baseline HRQoL and covariates, compared with participants who continued a regular frequency, participants who decreased their frequency had significantly lower physical (B = -4.42; P < .001) and mental (B = -3.95; P < .001) HRQoL at follow-up; participants who continued a low frequency also had significantly lower physical (B = -5.45; P < .001) and mental (B = -4.10; P < .001) HRQoL at follow-up. The follow-up HRQoL of participants who increased their frequency was similar to those who continued a regular frequency. CONCLUSIONS: Maintaining or increasing to a regular frequency of PA are associated with maintaining or improving physical and mental HRQoL. Our findings support the development of health promotion and long-term care strategies to encourage older adults to maintain a regular frequency of PA to promote their HRQoL.

Socio-demographic characteristics associated with emotional and social loneliness among older adults.

BACKGROUND: International studies provide an overview of socio-demographic characteristics associated with loneliness among older adults, but few studies distinguished between emotional and social loneliness. This study examined socio-demographic characteristics associated with emotional and social loneliness. METHODS: Data of 2251 community-dwelling older adults, included at the baseline measure of the Urban Health Centers Europe (UHCE) project, were analysed. Loneliness was measured with the 6-item De Jong-Gierveld Loneliness Scale. Multivariable logistic regression models were used to evaluate associations between age, sex, living situation, educational level, migration background, and loneliness. RESULTS: The mean age of participants was 79.7 years (SD = 5.6 years); 60.4% women. Emotional and social loneliness were reported by 29.2 and 26.7% of the participants; 13.6% experienced emotional and social loneliness simultaneously. Older age (OR: 1.16, 95% CI: 1.06-1.28), living without a partner (2.16, 95% CI: 1.73-2.70), and having a low educational level (OR: 1.82, 95% CI: 1.21-2.73), were associated with increased emotional loneliness. Women living with a partner were more prone to emotional loneliness than men living with a partner (OR: 1.78, 95% CI: 1.31-2.40). Older age (OR: 1.11, 95% CI: 1.00-1.22) and having a low educational level (OR: 1.77, 95% CI: 1.14-2.74) were associated with increased social loneliness. Men living without a partner were more prone to social loneliness than men living with a partner (OR: 1.94, 95% CI: 1.35-2.78). CONCLUSIONS: Socio-demographic characteristics associated with emotional and social loneliness differed regarding sex and living situation. Researchers, policy makers, and healthcare professionals should be aware that emotional and social loneliness may affect older adults with different socio-demographic characteristics.

The Influence of Simulated Sunlight on the Inactivation of Influenza Virus in Aerosols.

BACKGROUND: Environmental parameters, including sunlight levels, are known to affect the survival of many microorganisms in aerosols. However, the impact of sunlight on the survival of influenza virus in aerosols has not been previously quantified. METHODS: The present study examined the influence of simulated sunlight on the survival of influenza virus in aerosols at both 20% and 70% relative humidity using an environmentally controlled rotating drum aerosol chamber. RESULTS: Measured decay rates were dependent on the level of simulated sunlight, but they were not significantly different between the 2 relative humidity levels tested. In darkness, the average decay constant was 0.02 ± 0.06 min-1, equivalent to a half-life of 31.6 minutes. However, at full intensity simulated sunlight, the mean decay constant was 0.29 ± 0.09 min-1, equivalent to a half-life of approximately 2.4 minutes. CONCLUSIONS: These results are consistent with epidemiological findings that sunlight levels are inversely correlated with influenza transmission, and they can be used to better understand the potential for the virus to spread under varied environmental conditions.

ELX-02 Generates Protein via Premature Stop Codon Read-Through without Inducing Native Stop Codon Read-Through Proteins.

ELX-02 is a clinical stage, small-molecule eukaryotic ribosomal selective glycoside acting to induce read-through of premature stop codons (PSCs) that results in translation of full-length protein. However, improved read-through at PSCs has raised the question of whether native stop codon (NSC) fidelity would be impacted. Here, we compare read-through by ELX-02 in PSC and NSC contexts. DMS-114 cells containing a PSC in the TP53 gene were treated with ELX-02 and tested for increased nuclear p53 protein expression while also monitoring two other proteins for NSC read-through. Additionally, blood samples were taken from healthy subjects pre- and post-treatment with ELX-02 (0.3-7.5 mg/kg). These samples were processed to collect white blood cells and then analyzed by western blot to identify native and potentially elongated proteins from NSC read-through. In a separate experiment, lymphocytes cultivated with vehicle or ELX-02 (20 and 100 µg/ml) were subjected to proteomic analysis. We found that ELX-02 produced significant read-through of the PSC found in TP53 mRNA in DMS-114 cells, resulting in increased p53 protein expression and consistent with decreased nonsense-mediated mRNA degradation. NSC read-through protein products were not observed in either DMS-114 cells or in clinical samples from subjects dosed with ELX-02. The number of read-through proteins identified by using proteomic analysis was lower than estimated, and none of the NSC read-through products identified with >2 peptides showed dose-dependent responses to ELX-02. Our results demonstrate significant PSC read-through by ELX-02 with maintained NSC fidelity, thus supporting the therapeutic utility of ELX-02 in diseases resulting from nonsense alleles. SIGNIFICANCE STATEMENT: ELX-02 produces significant read-through of premature stop codons leading to full-length functional protein, demonstrated here by using the R213X mutation in the TP53 gene of DMS-114 cells. In addition, three complementary techniques suggest that ELX-02 does not promote read-through of native stop codons at concentrations that lead to premature stop codon read-through. Thus, ELX-02 may be a potential therapeutic option for nonsense mutation-mediated genetic diseases.

Accuracy of Grading in Pancreatic Neuroendocrine Neoplasms and Effect on Survival Estimates: An Institutional Experience.

BACKGROUND: Accurate grading of neuroendocrine neoplasms (NENs) is crucial for proper assessment of prognosis. Estimation of the proliferative indices, if not performed properly, is largely erroneous due to significant intratumoral heterogeneity. We sought to establish the degree of error in the grading of a cohort of curatively resected pancreatic NENs (PanNENs) and the theoretical impact of that in a larger cohort of Surveillance, Epidemiology, and End Results (SEER) patients. METHODS: A retrospective query of an institutional surgical database was performed from 2000 to 2018 to identify optimally resected PanNENs, which were reviewed by two gastrointestinal pathologists and regraded according to the WHO 2017 classification. Overall survival and recurrence-free survival were estimated using the Kaplan-Meier method for original and new grading systems, respectively and Cox proportional hazards models were used to evaluate the effect of the interested variables, including new grading systems. RESULTS: A total of 176 cases were identified. After regrading, 17/64 (26.6%) G1 neoplasms were classified as G2 and 12/95 (12.6%) G2 neoplasms were classified as G1, while 1/11 (9.1%) G3 neoplasms were classified as G2. Our expert gastrointestinal pathologists agreed on 97% of reclassified cases by blind review. Application of the G1/G2 misclassification errors on various groups, including PanNENs, in a SEER database of 1385 patients rendered the reported survival differences nonsignificant (1000 repetitions; p = 0.063, 95% confidence interval 0.056-0.070). CONCLUSIONS: Mischaracterization of grade is common in optimally resected PanNENs but is eliminated with proper training and adherence to guidelines. The discrepancy rates can cast doubt on the generally accepted survival differences between G1 and G2 patients, as surmised by large database analyses.

Survival Outcomes Associated With Clinical and Pathological Response Following Neoadjuvant FOLFIRINOX or Gemcitabine/Nab-Paclitaxel Chemotherapy in Resected Pancreatic Cancer.

OBJECTIVE: To compare the survival outcomes associated with clinical and pathological response in pancreatic ductal adenocarcinoma (PDAC) patients receiving neoadjuvant chemotherapy (NAC) with FOLFIRINOX (FLX) or gemcitabine/nab-paclitaxel (GNP) followed by curative-intent pancreatectomy. BACKGROUND: Newer multiagent NAC regimens have resulted in improved clinical and pathological responses in PDAC; however, the effects of these responses on survival outcomes remain unknown. METHODS: Clinicopathological and survival data of PDAC patients treated at 7 academic medical centers were analyzed. Primary outcomes were overall survival (OS), local recurrence-free survival (L-RFS), and metastasis-free survival (MFS) associated with biochemical (CA 19-9 decrease ≥50% vs <50%) and pathological response (complete, pCR; partial, pPR or limited, pLR) following NAC. RESULTS: Of 274 included patients, 46.4% were borderline resectable, 25.5% locally advanced, and 83.2% had pancreatic head/neck tumors. Vein resection was performed in 34.7% and 30-day mortality was 2.2%. R0 and pCR rates were 82.5% and 6%, respectively. Median, 3-year, and 5-year OS were 32 months, 46.3%, and 30.3%, respectively. OS, L-RFS, and MFS were superior in patients with marked biochemical response (CA 19-9 decrease ≥50% vs <50%; OS: 42.3 vs 24.3 months, P < 0.001; L-RFS-27.3 vs 14.1 months, P = 0.042; MFS-29.3 vs 13 months, P = 0.047) and pathological response [pCR vs pPR vs pLR: OS- not reached (NR) vs 40.3 vs 26.1 months, P < 0.001; L-RFS-NR vs 24.5 vs 21.4 months, P = 0.044; MFS-NR vs 23.7 vs 20.2 months, P = 0.017]. There was no difference in L-RFS, MFS, or OS between patients who received FLX or GNP. CONCLUSION: This large, multicenter study shows that improved biochemical, pathological, and clinical responses associated with NAC FLX or GNP result in improved OS, L-RFS, and MFS in PDAC. NAC with FLX or GNP has similar survival outcomes.

A coordinated preventive care approach for healthy ageing in five European cities: A mixed methods study of process evaluation components.

AIMS: To evaluate specific process components of the Urban Health Centres Europe (UHCE) approach; a coordinated preventive care approach aimed at healthy ageing by decreasing falls, polypharmacy, loneliness and frailty among older persons in community settings of five cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain. DESIGN: Mixed methods evaluation of specific process components of the UHCE approach: reach of the target population, dose of the intervention actually delivered and received by participants and satisfaction and experience of main stakeholders involved in the approach. METHODS: The UHCE approach intervention consisted of a preventive assessment, shared decision-making on a care plan and enrolment in one or more of four coordinated care-pathways that targeted falls, polypharmacy, loneliness and frailty. Quantitative data from a questionnaire and quantitative/qualitative data from logbooks were collected among older persons involved in the approach. Qualitative data from focus groups were collected among older persons, informal caregivers and professionals involved in the approach. Quantitative data were analysed by means of descriptive statistics and multilevel logistic regression models. Qualitative data were analysed through thematic analysis. RESULTS: Having limited function was associated with non-enrolment in falls and loneliness care-pathways (both p < .01). The mean rating of the approach was 8.3/10 (SD 1.9). Feeling supported by a care professional and meeting people were main benefits for older persons. Mistrust towards unfamiliar care providers, lack of confidence to engage in care activities and health constraints were main barriers towards engagement in care. CONCLUSIONS: Although the UHCE approach was received generally positively, health constraints and psychosocial barriers prevented older person's engagement in care. IMPACT: Coordinated preventive care approaches for older community-dwelling persons should address health constraints and psychosocial barriers that hinder older person's engagement in care. TRIAL REGISTRATION: ISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.

Fibrin tissue adhesive versus nasal packing in endoscopic nasal surgery: a systematic review and meta-analysis.

BACKGROUND: It has been proposed that fibrin tissue adhesive (FTA) can act as an effective alternative to nasal packing in managing the postoperative symptoms of endoscopic nasal surgery. METHODOLOGY: MEDLINE, Embase, Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov were searched for randomised controlled trials comparing FTA with nasal packing in endoscopic nasal surgery. The primary outcome of interest was bleeding; secondary outcomes included pain, nasal obstruction, infection, adhesions and the formation of granulation tissue. All trials underwent a risk of bias assessment, and a meta-analysis was performed using a random effects model. RESULTS: 315 studies were found, of which four were eligible for inclusion (n = 152). Bleeding was reported in all, with the meta-analysis favouring the packing group, although this was not significant. Nasal obstruction and granulation severity were significantly lower in the FTA group, however, no difference was noted for the outcomes of pain, infection or adhesions. CONCLUSION: Our results indicate minor advantages for using FTA over nasal packing. Unfortunately, the included studies show significant heterogeneity and risk of bias. Based on the available evidence, clinicians must balance the higher cost of FTA against the limited advantages for the patient.

What factors are associated with the prevalence of atopic symptoms amongst adolescents in Greater Manchester?

INTRODUCTION: Atopy commonly manifests itself as atopic diseases (ADs), namely asthma, eczema and hay fever. The prevalence of AD is rising worldwide, and it is widely accepted as a major public health issue, due to the significant burden of AD on health care systems. METHOD: Data were obtained from the youth survey of the European Urban Health Indicator System 2 project. The study participants were students aged 14-16 years from Greater Manchester. The main outcomes measured were the prevalence of atopic symptoms and the factors associated with the development of atopy. RESULTS: Of the sample studied, 70% reported having had an AD during their lifetime. The lifetime prevalence of ever having asthma, eczema or hay fever was 33.4%, 28.1% and 49.0%, respectively. Gender, family affluence, body mass index, diet, smoking and worrying were all significantly associated with atopic symptoms. Smoking was the only variable to be significantly associated with all three ADs. Season of birth and pollution were not shown to be associated with atopic symptoms. CONCLUSION: This study demonstrates that the prevalence of AD in Greater Manchester was high amongst adolescents. Several environmental, demographic and social factors were found to be significantly associated with the development of atopic symptoms. This study provides a baseline for future studies to further investigate the factors that are associated with AD and allow for the implementation of preventative public health policy.

Factors associated with the prevalence of adolescent binge drinking in the urban areas of Greater Manchester.

Background: Binge drinking in adolescents is a serious problem that has been recognised for over a generation. On average 61% of students in the European region had consumed alcohol in the last 30 days and 43% had participated in binge drinking in the same period. This article investigates the prevalence of adolescent binge drinking and the factors associated with this prevalence in urban areas of Greater Manchester. Methods: Data were obtained from the youth survey of the European Urban Health Indicator System 2 project. Study participants were school students aged 14-16 from the urban areas of Greater Manchester. The main outcome measures were adolescent binge drinking prevalence in Greater Manchester and the socio-demographic factors influencing it. Results: Greater Manchester had an adolescent binge drinking prevalence of 49.8%. Individual factors associated with increased prevalence of binge drinking were: age, substance use, school performance and early initiation of drinking (all significant at χ2, P < 0.05). Peer factors associated with increased prevalence of binge drinking were spending evenings with friends, keeping in touch with friends, having a good relationship with peers and self-reported bullying behaviours (all significant at χ2, P < 0.05). Family support lowered the prevalence of adolescent binge drinking. Conduct problems, family affluence and perceived local crime increased the prevalence of adolescent binge drinking. Conclusions: Binge drinking is highly prevalent in Greater Manchester adolescents. Various individual, peer-related, family-related and community-related factors were associated with this problem. Any attempt to tackle the prevalence of adolescent binge drinking must take into account all of these factors.

Methods for the isolation and 3D culture of dermal papilla cells from human hair follicles.

The dermal papilla is a cluster of mesenchymal cells located at the base of the hair follicle which have a number of important roles in the regulation of hair growth. As a consequence, in vitro models of these cells are widely used to study the molecular mechanisms which underlie hair follicle induction, growth and maintenance. While dermal papilla from rodent hair follicles can be digested prior to cell isolation, the unique extracellular matrix composition found in human dermal papilla renders enzymes such as trypsin and collagenase insufficient for digestion of the dermal papilla into a single cell suspension. As such, to grow human dermal papilla cells in vitro, the papilla has to first be isolated via a micro-dissection approach from the follicle. In this article we describe the micro-dissection and culture methods, which we use within our laboratory, for the study of human dermal papilla cells.

Evaluation design of Urban Health Centres Europe (UHCE): preventive integrated health and social care for community-dwelling older persons in five European cities.

BACKGROUND: Older persons often have interacting physical and social problems and complex care needs. An integrated care approach in the local context with collaborations between community-, social-, and health-focused organisations can contribute to the promotion of independent living and quality of life. In the Urban Health Centres Europe (UHCE) project, five European cities (Greater Manchester, United Kingdom; Pallini (in Greater Athens Area), Greece; Rijeka, Croatia; Rotterdam, the Netherlands; and Valencia, Spain) develop and implement a care template that integrates health and social care and includes a preventive approach. The UHCE project includes an effect and process evaluation. METHODS: In a one-year pre-post controlled trial, in each city 250 participants aged 75+ years are recruited to receive the UHCE approach and are compared with 250 participants who receive 'care as usual'. Benefits of UHCE approach in terms of healthy life styles, fall risk, appropriate medication use, loneliness level and frailty, and in terms of level of independence and health-related quality of life and health care use are assessed. A multilevel modeling approach is used for the analyses. The process evaluation is used to provide insight into the reach of the target population, the extent to which elements of the UHCE approach are executed as planned and the satisfaction of the participants. DISCUSSION: The UHCE project will provide new insight into the feasibility and effectiveness of an integrated care approach for older persons in different European settings. TRIAL REGISTRATION: ISRCTN registry number is ISRCTN52788952 . Date of registration is 13/03/2017.

The relationship between self-reported health status and signs of psychological distress within European urban contexts.

Background: Self-reported health status (SRHS) reflects an individual's perception of their social, biological and psychological health, and has been linked to increased mortality risk and increased use of health services. Having a psychological co-morbidity can reduce health outcomes and increase healthcare costs. This paper investigates the relationship between SRHS and signs of psychological distress (PD) in European urban settings. The study sample comprised 20 439 adult respondents to surveys conducted across 37 urban areas. Data on SRHS, signs of PD and potential confounders were analysed in a multivariable logistic regression. After adjusting for potential confounders (gender, age, time lived in country and regularity of contact with family and friends), a significant association was found between PD and self-reported poor health for all urban areas, particularly in Western European countries (adjusted OR = 3.615, 95% CI: 3.333-3.920 P < 0.001). Time lived in country of residence, financial stability and regularity of contact with family and friends were negatively associated with signs of PD in the adjusted model. There is a statistically significant association between self-reported poor health and signs of PD. Although the relationship was present in all geographical locations, the confounders were protective factors for Western European countries. Since the two factors are linked, interventions that target one might reduce the impact on both. Further study into causality would be of use in predicting future healthcare costs, which could be reduced by integrating their management.

The relationship between physical activity and self-rated health status in European adolescents: Results of the EURO-URHIS 2 survey.

Background: Engaging in regular physical activity has a beneficial impact on both physical health and on subjective health indicators. The aims of this study were (i) to assess the association between physical activity levels and self-reported health status in European adolescents and (ii) to identify any differences in the distribution of adolescents reporting good health between active and inactive subjects across urban areas. The study sample comprised 13 783 15-year olds from 21 urban areas across Europe who participated in the European Urban Health Indicators System Part 2 youth survey in 2010/11. Data collected on physical activity levels, self-rated health status and covariates including gender, BMI, socioeconomic status and sedentary behaviour were analyzed in a multivariable logistic regression model. High levels of physical activity (OR: 1.607, 95% CI: 1.245-2.074, P < 0.001) were associated with self-rated 'good health' across the cohort as a whole. All cities except Iasi showed a positive association between high levels of physical activity and good health. This was significant in four cases: Amsterdam, Cardiff, Greater Manchester and Merseyside ( P = 0.035, 0.016, 0.010 and 0.049, respectively). Only 13.3% of the cohort met the current WHO physical activity level recommendations. High levels of physical activity are positively associated with self-rated 'good health' status in European adolescents. Alarming levels of physical inactivity make it a priority to encourage greater engagement in physical activity. Promotion of physical activity should be specifically tailored to each urban area.