Physical activity trajectories from childhood to late adolescence and their implications for health in young adulthood.

Physical activity has been associated with physical and mental health across the life course, yet few studies have used group-based trajectory modeling to examine the effect of longitudinal patterns of physical activity during childhood and adolescence on adult health outcomes. The Raine Study data from Gen2 follow-ups at 8, 10, 14, 17, 20, and 22 years collected between 1998 and 2014 were used. Latent class analysis identified trajectories using parent-reported physical activity for ages 8 to 17. Associations between trajectories and physical and mental health outcomes at ages 20 and 22 were explored, adjusting for current physical activity and considering sex interactions. Analysis in 2019 identified three trajectories: low (13%), mid (65%) and high (22%) physical activity (n = 1628). Compared to the low-activity trajectory, those in the high-activity trajectory had lower adiposity, insulin, HOMA-IR and fewer diagnosed disorders, higher HDL-cholesterol, and faster cognitive processing. For example, those in the high-activity trajectory had lower percent body fat at age 20 compared to those in the mid-activity (-4.2%, 95%CI: -5.8, -2.7) and low-activity (-9.5%, 95%CI: -11.7, -7.2) trajectories. Physical activity trajectories showed different associations between sexes for self-reported physical and mental health, BMI, systolic blood pressure, and depression symptoms. Being in the high- or mid-activity trajectory was associated with a more favorable cardiometabolic and mental health profile in young adulthood. Strategies are needed to help less active children to increase physical activity throughout childhood and adolescence to improve young adult health outcomes.

'Exercise to me is a scary word': perceptions of fatigue, sleep dysfunction, and exercise in people with fibromyalgia syndrome-a focus group study.

Fibromyalgia syndrome (FMS) is a common and complex chronic pain condition. Exercise is recommended in the management of the FMS; however, people with FMS often find exercise exacerbates their condition and causes overwhelming fatigue. The objective of this study was to explore the perceptions of fatigue and sleep dysfunction, and exercise in people with FMS. Three, 60-90 min focus groups were conducted with people with FMS (n = 14). Participants were recruited from patient support groups who had experienced therapeutic exercise in the management of their condition. Focus groups were video and audio recorded and transcriptions analysed for thematic content by three independent evaluators. Fatigue, sleep dysfunction, and pain were universally reported by participants. The over-arching theme to emerge was a lack of understanding of the condition by others. A huge sense of loss was a major sub-theme and participants felt that they had fundamentally changed since the onset of FMS. Participants reported that they were unable to carry out their normal activities, including physical activity and exercise. The invisibility of FMS was associated with the lack of understanding by others, the sense of loss, and the impact of FMS. People with FMS perceive that there is a lack of understanding of the condition among health care professionals and the wider society. Those with FMS expressed a profound sense of loss of their former 'self'; part of this loss was the ability to engage in normal physical activity and exercise.

Standard vs. intensified management of heart failure to reduce healthcare costs: results of a multicentre, randomized controlled trial.

AIMS: To determine if an intensified form of heart failure management programme (INT-HF-MP) based on individual profiling is superior to standard management (SM) in reducing health care costs during 12-month follow-up (primary endpoint). METHODS AND RESULTS: A multicentre randomized trial involving 787 patients (full analysis set) discharged from four tertiary hospitals with chronic HF who were randomized to SM (n = 391) or INT-HF-MP (n = 396). Mean age was 74 ± 12 years, 65% had HF with a reduced ejection fraction (31.4 ± 8.9%) and 14% were remote-dwelling. Study groups were well matched. According to Green, Amber, Red Delineation of rIsk And Need in HF (GARDIAN-HF) profiling, regardless of location, patients in the INT-HF-MP received a combination of face-to-face (home visits) and structured telephone support (STS); only 9% (`low risk') were designated to receive the same level of management as the SM group. The median cost in 2017 Australian dollars (A$1 equivalent to ∼EUR €0.7) of applying INT-HF-MP was significantly greater than SM ($152 vs. $121 per patient per month; P < 0.001), However, at 12 months, there was no difference in total health care costs for the INT-HF-MP vs. SM group (median $1579, IQR $644 to $3717 vs. $1450, IQR $564 to $3615 per patient per month, respectively). This reflected minimal differences in all-cause mortality (17.7% vs. 18.4%; P = 0.848) and recurrent hospital stay (18.6 ± 26.5 vs. 16.6 ± 24.8 days; P = 0.199) between the INT-HF-MP and SM groups, respectively. CONCLUSION: During 12-months follow-up, an INT-HF-MP did not reduce healthcare costs or improve health outcomes relative to SM.

Injection site infections and injuries in men who inject image- and performance-enhancing drugs: prevalence, risks factors, and healthcare seeking.

People who inject drugs are vulnerable to infections and injuries at injection sites, but these have rarely been studied in those injecting image- and performance-enhancing drugs (IPEDs). This study examined the factors associated with reported symptoms of injection site infections and injuries in IPED injectors. Of the 366 male IPED injectors surveyed, 42% reported ever having redness, swelling and tenderness (36% in the preceding year), and 6·8% had ever had an abscess or open wound at an injection site. Having these symptoms was associated with a range of factors related to drug use and healthcare utilization. One sixth (17%) of those reporting redness, tenderness and swelling had ever sought treatment, as had the majority (76%) of those reporting an abscess, sore or open wound. Most common sources of advice were emergency clinics and General Practitioners. Interventions are needed to support access to appropriate injecting equipment and provide targeted harm reduction advice.

Habitual Physical Activity, Sedentary Behaviour and Bone Health in Rheumatoid Arthritis.

Associations between habitual physical activity levels and bone health in rheumatoid arthritis (RA) were assessed. Twenty nine female patients with RA were assessed for bone mineral density (BMD), and classified as having low or normal hip BMD. Habitual physical activity levels were assessed using accelerometry, and disease activity was assessed using the Clinical Disease Activity Index (CDAI). Twenty one patients had normal bone mass, while 8 had low bone mass. There was no difference in age in the normal bone mass group (51(8)) compared to the low bone mass group (57(12)), p=0.19. Patients with normal bone mass spent on average 2 h less per day in sedentary activity (65(4)% vs. 73(2)%, p<0.01), over 70 min more time in light activity (23(1)% vs. 18(2)%, p<0.01), and over 50 min more in moderate activity per day (12(3)% vs. 8(2)%, p<0.01) than did patients with low bone mass, independently of disease activity or duration. Patients with normal bone mass broke up their sedentary time more frequently per day (72(21) vs. 53(18) times per day, p=0.03). The results of this study indicate that higher habitual activity levels may be protective of bone health in patients with RA, and should be encouraged.

Osteogenic effects of a physical activity intervention in South African black children.

OBJECTIVES: To determine whether a weight-bearing physical activity intervention improves measures of bone density, size and strength in a pre- and early pubertal cohort of black South African children. METHODS: Twenty two school children (9.7±1.1 years) were cluster randomised into an exercise (EX; n=12) and control (CON; n=10) group. EX children performed a weight-bearing exercise program for 20 weeks. CON children continued their regular activities. Whole body DXA and tibial peripheral QCT scans were obtained. Urine was analysed for concentrations of cross-linked N-telopeptides of Type I collagen (NTX). RESULTS: Changes in 4% volumetric BMD, area and strength were greater in EX than CON. At the 38% site, change in bone area and density was greater in EX than CON. The greater change in periosteal circumference in the EX groups also resulted in a greater change in cortical thickness of the tibia compared to the CON group. NTX concentration was lower in the EX group than the CON group after the intervention. CONCLUSIONS: This study documents for the first time the beneficial response of trabecular and cortical bone of black children to a weight bearing exercise intervention.

Whole body vibration increases hip bone mineral density in road cyclists.

This study aimed to determine the effects of 10 weeks of whole body vibration training on the bone density of well-trained road cyclists. 15 road cyclists were assigned to either a vibrating group (n=8), who undertook 15 min of intermittent whole body vibration at 30 Hz, 3 times per week while continuing with their normal cycling training; or a control group (n=7), who continued with their normal cycling training for the 10-week period. Cyclists were age, body mass and height matched with 15 sedentary participants. At baseline, all participants underwent regional dual x-ray absorptiometry scans, where both cycling groups had lower pelvic (p<0.050) and higher head bone mineral density (p<0.050) than the sedentary participants with no other differences observed. After 10 weeks of training, vibrating cyclists showed a significantly greater increase in hip bone mineral density (0.020±0.010 g.cm - 2 (1.65%), p=0.024) while the control cyclists ( - 0.004±0.001 g.cm - 2 (0%)) showed no change (p>0.050). The control group had a significantly lower spine bone mineral density (1.027±0.140 g.cm - 2, p=0.020) compared to baseline (1.039±0.140 g.cm - 2). This loss was not observed in the vibrating group. 10 weeks of whole body vibration training increased hip and preserved spine bone mineral density in road cyclists.

Where are all the surgeons in clinical academia?

INTRODUCTION: High-quality research into surgical disease will benefit surgical patients. Whereas nearly one-fifth of National Health Service (NHS) England consultants are surgeons, less than 5% of the government's health research funding supports surgical research. METHODS: Using an observational study, we identified surgeons in active research fellowships and on selection panels for the three largest pan-specialty medical funding bodies in the UK. We quantified the proportion of editorial board members that are surgeons, and the proportion of surgical research published over a 1-year period in the New England Journal of Medicine, The Lancet and the British Medical Journal. RESULTS: Some 185/1,579 (12%) of research fellowships held by clinicians were awarded to surgeons, with relatively fewer surgeons holding senior fellowships compared with predoctoral fellowships. Across the three research funding bodies, 9/165 (5%) of the clinical panel members were surgeons, whereas for the three pan-specialty journals, 5/84 (6%) of the clinical editorial board members were surgeons. Of the 541 original articles published by the same three journals, only 45 (8%) were classified as surgical. CONCLUSIONS: We show that surgeons were underrepresented across differing domains of clinical academia. The causes of this are likely multifactorial; there are fewer senior surgeons occupying decision-making positions, fewer role models in senior fellowship positions and surgical training may leave less time to engage in research. We propose further qualitative research within the surgical community, funding bodies and journals to understand the origins of the problem and begin to form evidence-based solutions.

The effect of 6-week exercise programme and whole body vibration on strength and quality of life in women with fibromyalgia: a randomised study.

OBJECTIVES: The aim of this study was to investigate the effectiveness of a 6-week traditional exercise programme with supplementary whole-body vibration (WBV) in improving strength and health status in women with fibromyalgia (FM). METHODS: Thirty postmenopausal women with FM (mean (SD) age: 59 (7.90) years) were randomised into one of two groups, one intervention group (GEV n=15), which combined exercise training (two days a week) with three days of WBV (3 sets of 45 s at 20 Hz-3 mm and four sets of unilateral static squats at 20 Hz-2 mm) and another control group (n=15), that performed the same physical activity programme but without vibration training (GEnV). The Fibromyalgia Impact Questionnaire (FIQ) and the global score of the SF-36 were used to assess functional capacity and quality of life. Two additional tests were employed to assess muscle strength. Baseline data and pre-test and post-test data were collected before and after the six-week intervention period. RESULTS: Significant improvements in all outcomes measured were found from baseline in both groups. A 5% improvement from baseline in total FIQ score was observed in the exercise groups (p≤0.05), and was accompanied by reductions in SF36 scores of 9.8% (p<0.001) and 7.9% (p<0.001) in the GEV and GEnV group, respectively. Improvements were also observed in muscle strength in both groups but greater in the GEV group. CONCLUSIONS: The results suggest that women with FMS can gain additional health benefits by engaging in a 6-week traditional exercise programme with supplementary WBV.

Feasibility and preliminary effects of a peer-led motivationally-embellished workplace walking intervention: A pilot cluster randomized trial (the START trial).

Walking interventions can be effective in increasing physical activity amongst physically inactive employees. However, despite their promising potential regarding sustainability and scalability, peer-led workplace walking interventions have not been tested. We evaluated a peer-led workplace group walking intervention designed to engage physically inactive employees. A 16-week pilot cluster randomized controlled trial consisted of enhanced (5 worksites; n = 50 participants) and minimal treatment (3 worksites; n = 47) conditions. All participants were provided with a Fitbit Zip and information on health benefits of walking. Enhanced treatment participants had access to a mobile phone app incorporating behavior change techniques, were trained on principles of autonomous motivation, and had a peer leader trained in a motivationally supportive communication style. Feasibility assessments included recruitment and drop-out rates, assessment completion rates, training acceptability (walkers and peer leaders), and intervention acceptability (walkers only). Outcomes assessed included movement-related behaviors (assessed via activPAL devices), cardio-metabolic risk factors, motivation to walk, and well-being, and these measures were taken at baseline and post-intervention. The results supported intervention feasibility. Preliminary efficacy evidence was mixed. Markers of cardio-metabolic risk improved in the enhanced treatment only. Autonomous motivation increased in both conditions. There were no changes in step counts, standing, and sitting time, or well-being. Further fine tuning is needed before a definitive RCT. Australian and New Zealand Clinical Trials Registry: ACTRN12618000807257.

A high-throughput multi-microfluidic crystal generator (MMicroCryGen) platform for facile screening of polymorphism and crystal morphology for pharmaceutical compounds.

In this work, a novel multi-microfluidic crystallization platform called MMicroCryGen is presented, offering a facile methodology for generating individual crystals for fast and easy screening of the polymorphism and crystal habit of solid compounds. The MMicroCryGen device is capable of performing 8 × 10 cooling crystallization experiments in parallel using 8 disposable microcapillary film strips, each requiring less than 25 µL of solution. Compared to traditional microfluidic systems, the MMicroCryGen platform does not require complex fluid handling; it can be directly integrated with a 96-well microplate and it can also work in a "dipstick" mode. The produced crystals can be safely and directly observed inside the capillaries by optical and spectroscopic techniques. The platform was validated by performing a number of independent experimental runs for: (1) polymorph and hydrate screening of ortho-aminobenzoic acid, succinic acid and piroxicam; (2) co-crystal form screening of the p-toluenesulfonamide/triphenylphosphine oxide system; (3) studying the effect of o-toluic acid on ortho-aminobenzoic cooling crystallization (effect of structurally related additives). In all three cases, all known solid forms were identified with a single experiment using ∼200 µL of solvent and just a few micrograms of the solid material. The MMicroCryGen is simple to use, inexpensive and it provides increased flexibility compared to traditional crystallization techniques, being an effective new microfluidic solution for solid form screening in pharmaceutical, fine chemicals, food and agrochemical industries.

Targeted disruption of the murine fps/fes proto-oncogene reveals that Fps/Fes kinase activity is dispensable for hematopoiesis.

The fps/fes proto-oncogene encodes a cytoplasmic protein-tyrosine kinase that is functionally implicated in the survival and terminal differentiation of myeloid progenitors and in signaling from several members of the cytokine receptor superfamily. To gain further insight into the physiological function of fps/fes, we targeted the mouse locus with a kinase-inactivating missense mutation. Mutant Fps/Fes protein was expressed at normal levels in these mice, but it lacked detectable kinase activity. Homozygous mutant animals were viable and fertile, and they showed no obvious defects. Flow cytometry analysis of bone marrow showed no statistically significant differences in the levels of myeloid, erythroid, or B-cell precursors. Subtle abnormalities observed in mutant mice included slightly elevated total leukocyte counts and splenomegaly. In bone marrow hematopoietic progenitor cell colony-forming assays, mutant mice gave slightly elevated numbers and variable sizes of CFU-granulocyte macrophage in response to interleukin-3 (IL-3) and granulocyte-macrophage colony-stimulating factor (GM-CSF). Tyrosine phosphorylation of Stat3 and Stat5A in bone marrow-derived macrophages was dramatically reduced in response to GM-CSF but not to IL-3 or IL-6. This suggests a distinct nonredundant role for Fps/Fes in signaling from the GM-CSF receptor that does not extend to the closely related IL-3 receptor. Lipopolysaccharide-induced Erk1/2 activation was also reduced in mutant macrophages. These subtle molecular phenotypes suggest a possible nonredundant role for Fps/Fes in myelopoiesis and immune responses.

Effect of s-methylmethionine sulphonium chloride on oesophagogastric ulcers in pigs.

OBJECTIVE: To assess the value of s-methylmethionine sulphonium chloride (SMMSC) (200 mg/kg) on nutritional performance of pigs and as prevention or therapy for oesophagogastric ulcers. DESIGN: Sixty pigs from a high health status herd with continuing oesophagogastric ulcer problems were endoscopically assessed for the presence or absence of oesophagogastric ulcers. Forty-eight pigs were then selected and allocated according to an initial oesophagogastric epithelial (ulcer score) classification to replicated treatment groups in a 2 x 2 factorial design. Weight gain and feed intake were measured over 49 d, after which pigs were killed and stomachs were collected, re-examined and scored for oesophagogastric ulceration. RESULTS: There was no difference over the 49 d in weight gain, feed intake and backfat in pigs with and without SMMSC supplementation between pigs with or without fully developed oesophagogastric ulcers at the start of the study. In pigs with an initially low ulcer score, feeding SMMSC did not prevent further oesophagogastric ulcer development. No significant effect of SMMSC was apparent when final mean oesophagogastric ulcer scores were compared in pigs with existing high ulcer score. However, further analysis of the changes in individual pig oesophagogastric ulcer scores during the experiment showed that the observed reductions in scores of the high ulcer group was significantly different from all other groups. CONCLUSION: This study has indicated that supplementation of pig diets with SMMSC cannot be justified unless the slight ulcer score improvement observed could be translated to some commercial production advantage such as a reduction in pig mortalities due to oesophagogastric ulcers. This study has further confirmed the benefit of endoscopy as a tool to enable objective assessment of oesophageal gastric health.

Feeding sorghum ergot (Claviceps africana) to sows before farrowing inhibits milk production.

OBJECTIVE: To assess the impact of feeding different amounts of sorghum ergot to sows before farrowing. DESIGN: Fifty-one pregnant sows from a continually farrowing piggery were sequentially inducted into the experiment each week in groups of four to seven, as they approached within 14 days of farrowing. Diets containing sorghum ergot sclerotia within the range of 0 (control) up to 1.5% w/w (1.5% ergot provided 7 mg alkaloids/kg, including 6 mg dihydroergosine/kg) were randomly allocated and individually fed to sows. Ergot concentrations were varied with each subsequent group until an acceptable level of tolerance was achieved. Diets with ergot were replaced with control diets after farrowing. Post-farrowing milk production was assessed by direct palpation and observation of udders, and by piglet responses and growth. Blood samples were taken from sows on three days each week, for prolactin estimation. RESULTS: Three sows fed 1.5% ergot for 6 to 10 days preceding farrowing produced no milk, and 87% of their piglets died despite supplementary feeding of natural and artificial colostrums, milk replacer, and attempts to foster them onto normally lactating sows. Ergot inclusions of 0.6% to 1.2% caused lesser problems in milk release and neo-natal piglet mortality. Of 23 sows fed either 0.3% or 0.6% ergot, lactation of only two first-litter sows were affected. Ergot caused pronounced reductions in blood prolactin, and first-litter sows had lower plasma prolactin than multiparous sows, increasing their susceptibility to ergot. CONCLUSION: Sorghum ergot should not exceed 0.3% (1 mg alkaloid/kg) in diets of multiparous sows fed before farrowing, and should be limited to 0.1% for primiparous sows, or avoided completely.

Low levels of hepatitis C diagnosis and testing uptake among people who inject image and performance enhancing drugs in England and Wales, 2012-15.

INTRODUCTION: People injecting image and performance enhancing drugs (IPEDs) have traditionally not been perceived as being at high risk of hepatitis C virus (HCV) infection. However, recent studies indicate the HCV antibody (anti-HCV) prevalence in this group is 10-times that in the general population. HCV testing uptake and undiagnosed infections are examined using data from a voluntary unlinked-anonymous survey. METHOD: People injecting IPEDs across England and Wales completed a short bio-behavioural survey (2012-15). Anti-HCV status and self-reports of HCV testing were used in the analysis. RESULTS: The participants median age was 31 years, 98% were men, 14% had also injected psychoactive drugs and the anti-HCV prevalence was 4.8% (N=564). Among those who had never injected psychoactive drugs the anti-HCV prevalence was 1.4%; among those who had recently injected psychoactive drugs (preceding 12 months) prevalence was 39% and among those who had done this previously 14% (p<0.001). Overall, 37% had been tested for HCV: among those who had recently injected psychoactive drugs 78% had been tested, as had 56% of those who had injected psychoactive drugs previously; 33% of those never injecting psychoactive drugs were tested (p<0.001). Overall, 44% of those with anti-HCV were aware of this; however, only 14% of those who had never injected psychoactive drugs were aware. CONCLUSIONS: One-in-twenty people who inject IPEDs have anti-HCV. HCV infections among those who had never injected psychoactive drugs were mostly undiagnosed, though this group had a lower prevalence. Targeted HCV testing interventions are also needed for those injecting IPEDs.

The ability of two commercially available quick test kits to detect drug-facilitated sexual assault drugs in beverages.

AIMS: Assessment of the sensitivity and specificity of two commercially available 'drug-facilitated sexual assault' drug detector kits, Drink Guard and Drink Detective. DESIGN: Experimental. SETTING: Laboratory. MEASUREMENTS: Gamma hydroxybutyrate (GHB) sodium salt, ketamine hydrochloride, temazepam, flunitrazepam and diazepam were dissolved (Tween added to benzodiazepine solutions) as separate stock solutions and added to 330 ml samples of cola (Pepsi Max), beer (Stella Artois), 'alcopop' (Bacardi Breezer) and placebo (distilled water). The doses used are reported to be common in cases of intoxication. Each kit was tested 10 times for each drink/drug combination. Two blind, independent observers scored each test (presence/absence of drug) in accordance with kit instructions; chi 2 was used to compare the proportion of times raters scored tests correctly and incorrectly. Sensitivity and specificity were calculated overall, for each drink, and sensitivity was calculated for each drug. Inter-observer agreement was evaluated using the kappa statistic. FINDINGS: While both raters were able to score significantly more tests correctly than incorrectly using Drink Detective, and one rater scored similarly using Drink Guard, the overall sensitivity of Drink Detective and Drink Guard was 69.0% (95% CI 64.2-73.5%) and 37.5% (95% CI 30.1-45.5%), respectively. Sensitivity was drink-dependent. Drink Detective was unable to detect our dose of GHB in water, with all tests scored negatively by both raters for this drink/drug combination (n = 20 negative scores). Overall, specificity was 76.6% (95% CI 71.5-81.0%) and 87.9% (95% CI 83.0-91.6%) for Drink Guard and Drink Detective, respectively, but was affected by the beverage. Inter-rater agreement was poor for Drink Guard (kappa = 0.278 +/- 0.069) but excellent for Drink Detective (kappa = 0.894 +/- 0.245). Inter-observer agreement was drug-dependent. CONCLUSIONS: Use of drug detector kits by the public in the night-time environment needs further investigation and may create a false sense of security (false negatives) and undue concern (false positives) among kit users.

The production of interleukin-11 and decidualization are compromised in endometrial stromal cells derived from patients with infertility.

IL-11 signaling is critical for decidualization of the endometrial stroma in early pregnancy in the mouse. In this study, we investigate the function of IL-11 signaling in cAMP-induced decidualization of human endometrial stromal cells. We show that treatment of endometrial stromal cells with 8-bromo-cAMP (8-Br-cAMP) results in an increase in the levels of secreted IL-11, whereas levels of cell surface IL-11 receptor alpha are similar with or without 8-Br-cAMP treatment. The production of IL-11 correlates with the production of molecular markers of decidualization, prolactin and IGF-binding protein-1. The expression of these markers is inhibited when IL-11 signaling is specifically blocked in decidualizing endometrial stromal cells by the IL-11 antagonist W147A. We demonstrate that 8-Br-cAMP-induced endometrial stromal cells derived from patients with primary infertility produce lower levels of prolactin, IGF-binding protein-1, and IL-11 than cells derived from fertile women. Our results suggest that IL-11 expression is critically important during decidualization in the human endometrium, and that aberrant regulation of endometrial IL-11 production may be associated with some types of infertility.

Effects of nightlife activilty on health.

This article aims to increase understanding of nightlife health and the potential for nurses to reduce some of the negative health consequences associated with nightlife activity.

Anabolic steroids detected in bodybuilding dietary supplements - a significant risk to public health.

Twenty-four products suspected of containing anabolic steroids and sold in fitness equipment shops in the United Kingdom (UK) were analyzed for their qualitative and semi-quantitative content using full scan gas chromatography-mass spectrometry (GC-MS), accurate mass liquid chromatography-mass spectrometry (LC-MS), high pressure liquid chromatography with diode array detection (HPLC-DAD), UV-Vis, and nuclear magnetic resonance (NMR) spectroscopy. In addition, X-ray crystallography enabled the identification of one of the compounds, where reference standard was not available. Of the 24 products tested, 23 contained steroids including known anabolic agents; 16 of these contained steroids that were different to those indicated on the packaging and one product contained no steroid at all. Overall, 13 different steroids were identified; 12 of these are controlled in the UK under the Misuse of Drugs Act 1971. Several of the products contained steroids that may be considered to have considerable pharmacological activity, based on their chemical structures and the amounts present. This could unwittingly expose users to a significant risk to their health, which is of particular concern for naïve users.