Barriers to physical activity and healthy diet among breast cancer survivors: A multilevel perspective.

Cancer survivors engage in suboptimal levels of health behaviours and report many barriers to health behaviours, but we lack a solid understanding of the different levels of barriers and how they relate to enacted health behaviours. To address these issues, we conducted mixed-method research in 97 breast cancer survivors. Participants' barriers to physical activity (PA) and healthy diet, asked as an open-ended question, were coded as individual-level, social-level, and organisational/environmental-level for each health behaviour. Moderate-to-vigorous PA and fruit and vegetable (F&V) intake were assessed. Most participants perceived at least one PA (72.7%) and diet (64.9%) individual-level barrier (e.g. physical symptoms/injury); only 15.2% (PA) and 15.6% (diet) reported at least one social-level barrier (e.g. family obligations). About 28.8% (PA) and 29.9% (diet) perceived at least one organisational/environmental-level barrier (e.g. job demand, cost of F&V). Survivors perceiving individual-level dietary barriers consumed less F&V (-.65 servings/day) than those not perceiving dietary barriers at this level. Survivors perceiving social-level dietary barriers reported marginally lower F&V intake (-.65 servings/day) than their counterparts. Those perceiving organisational/environmental-level PA barriers reported marginally fewer minutes (-44.30/week) of moderate-to-vigorous PA than their counterparts. Barriers at multiple levels should be addressed to improve health behaviours among breast cancer survivors.

Command, control and communication (C3) during the COVID-19 pandemic; adapting a military framework to crisis response in a tertiary UK critical care centre.

The COVID-19 pandemic of 2020 imposed significant strain on critical care services worldwide. The South London region experienced the largest numbers of critical care admissions in the United Kingdom with King's College Hospital one of the busiest centres. This article outlines, using a descriptive narrative, the significant changes that occurred within King's Critical Care as a result of the pandemic and the decisions that were taken to provide effective co-ordination and control to the expanded service, in part drawing on the military experience of two of the authors. The wider context of crisis and major incident leadership and management is also discussed contrasting different approaches used in civilian and military settings.

Identification of a B cell differentiation factor(s) spontaneously produced by proliferating T cells in murine lupus strains of the lpr/lpr genotype.

Lymph node and spleen cells of the autoimmune MRL/Mp-lpr/lpr mouse strain spontaneously produce (in the absence of mitogenic stimulation) a factor(s) that induces B cell differentiation. This factor is not produced by the congenic MRL/n mouse strain that lacks the lpr gene or by normal mouse strains. However, lymphoid cells of the B6-lpr/lpr (B6/1) strain also produce a B cell differentiation factor. Although the factor acts on resting B cells, its effect is greatly magnified by activating the B cells with anti-mu or lipopolysaccharide. MRL/l mice begin producing the factor as early as 1 mo of age but levels increase with age and appearance of lymphoproliferation. Cell depletion studies reveal that this factor is produced by T cells of the Lyt-1+2-phenotype. Because of its association with the lpr/lpr genotype, we term this B cell differentiation factor L-BCDF. Functional analysis of L-BCDF reveals that it acts regardless of cell density in culture and in the absence of interleukin 2 (IL-2). In fact, the increase in the production of L-BCDF by MRL/1 T cells with aging occurs concomitantly with a marked decrease in their ability to produce IL-2. No T cell replacing factor activity or B cell growth factor-like activity can be detected in MRL/l-derived supernatants. L-BCDF induces both IgM and IgG synthesis in lipopolysaccharide-activated B cells; however, it has a greater effect on IgG secretion. In particular, the production of IgG1, IgG2a, and IgG2b are markedly enhanced in the presence of L-BCDF. The spontaneous production of L-BCDF by T cells of SLE mice of lpr/lpr genotype suggests an association of this factor with autoimmunity.

Operational anaesthesia for the management of traumatic brain injury.

The primary brain insult that occurs at the time of head injury, is determined by the degree of neuronal damage or death and so cannot be influenced by further treatment. The focus of immediate and ongoing care from the point of wounding to intensive care management at Role 4 should be to reduce or prevent any secondary brain injury. The interventions and triage decisions must be reassessed at every stage of the process, but should focus on appropriate airway management, maintenance of oxygenation and carbon dioxide levels and maintenance of adequate cerebral perfusion pressure. Early identification of raised intracranial pressure and appropriate surgical intervention are imperative. Concurrent injuries must also be managed appropriately. Attention to detail at every stage of the evacuation chain should allow the head-injured patient the best chance of recovery.

Prehospital analgesia: systematic review of evidence.

The purpose of this systematic review is to investigate current evidence for analgesic use in the prehospital environment using expert military and civilian opinion to determine the important clinical questions. There was a high degree of agreement that pain should be no worse than mild, that pain relief be rapid (within 10 minutes), that patients should respond to verbal stimuli and not require ventilatory support, and that major adverse events should be avoided. Twenty-one studies provided information about 6212 patients; the majority reported most of the outcomes of interest. With opioids 60-70% of patients still had pain levels above 30/100 mm on a Visual Analogue Scale after 10 minutes, falling to about 30% by 30-40 minutes. Fascia iliaca blocks demonstrated some efficacy for femoral fractures. No patient on opioids required ventilatory support; two required naloxone; sedation was rare. Cardiovascular instability was uncommon. Main adverse events were dizziness or giddiness, and pruritus with opioids. There was little evidence regarding the prehospital use ofketamine.

Improving physical and mental health in frontline mental health care providers: Yoga-based stress management versus cognitive behavioral stress management.

The need for brief, low-cost, easily disseminable and effective interventions to promote healthy lifestyles is high. This is especially true for mental health providers. We developed two studies to compare the impacts of Cognitive Behavioral Stress Management (CBSM) and Yoga Based Stress Management (YBSM) interventions for healthcare professionals. Study 1 offered an 8-week YBSM intervention to 37 mental healthcare participants and collected health data pre and post. Study 2 offered YBSM and CBSM classes to 40 randomly assigned mental healthcare providers and collected mental and physical health data at four time points. In Study 1, using t-tests, the YBSM intervention affected a number of mental and physical wellbeing indices pre to post. In Study 2, using linear mixed modeling, both YBSM and CBSM groups improved significantly (p <.05) in fruit and vegetable intake, heart rate, alcohol consumption, relaxation and awareness, professional quality of life, compassion satisfaction, burnout, depression, and stress levels. There was a group by time effect for coping confidence (CBSM increased more, p<.05, F = 4.34), physical activity (YBSM increased more, p<.05, F = 3.47), overall mental health (YBSM increased more, p<.10, F =5.32), and secondary traumatic stress (YBSM decreased more, p<.10, F = 4.89). YBSM and CBSM appear to be useful for healthcare professionals' mental and physical health. YBSM demonstrates some benefit above and beyond the extremely well-studied and empirically supported CBSM, including increased physical activity, overall mental health, and decreased secondary traumatic stress benefits.

Influenza vaccination of children during acute asthma exacerbation and concurrent prednisone therapy.

OBJECTIVES: The influenza vaccination rate is very low among children with moderate to severe asthma. This may be partly because of poor patient motivation and failure to visit clinics for vaccination. Another important factor may be health care providers' deferral of vaccination because of concern about the efficacy and safety of influenza vaccination during asthma exacerbations and concurrent prednisone therapy. We therefore examined the safety and immunogenicity of influenza vaccination during acute asthma exacerbation with concomitant prednisone therapy. SETTING: A pediatric allergy and pulmonology clinic and a pediatric emergency department. DESIGN: Children (n = 109) with a known diagnosis of asthma 6 months to 18 years of age were recruited. All participating patients, 59 without asthma symptoms (no prednisone, control group) and 50 with acute asthma exacerbation requiring prednisone burst therapy (prednisone group) received trivalent subvirion influenza vaccine. Fifteen children in the control group and 12 in the prednisone group received a booster dose according to American Academy of Pediatrics guidelines. Serum antibody titers to influenza A/Beijing/32/92 (H3N2), influenza A/Texas/36/91 (H1N1), and influenza B/Panama/45/90 were measured before and 2 weeks after vaccination. Adverse effects noted within 48 hours after vaccine dose were ascertained during the follow-up visit. RESULTS: The antibody response was analyzed by comparing mean postvaccine titers, the percentage of patients achieving protective antibody levels (> or = 5log2), and the percentage of patients achieving rises in titers of 2log2 or greater. Antibody responses to influenza A/Beijing/32/92 (H3N2) and influenza A/Texas/36/91 (H1N1) in the prednisone-treated and control groups were not different. A significantly better response to the influenza B/Panama/45/90 antigen was seen in the prednisone group for all three parameters. Children who received a booster dose and the subgroup of children with low prevaccination titers (< or = 3log2) showed similar patterns. Adverse effects, including asthma exacerbation, local swelling at the injection site, fever, rash, and headache, were not different in the two groups. CONCLUSIONS: Influenza vaccination can be given safely and effectively to asthmatic children regardless of asthma symptoms or concurrent prednisone therapy when necessary. Vaccination of all moderate to severe asthmatic patients visiting clinics or emergency departments would improve the overall vaccination rate significantly.

Phase I study of busulfan, cyclophosphamide, and timed sequential escalating doses of cytarabine followed by bone marrow transplantation.

In both animal models and human studies in leukemia, residual disease on day 8 following myelosuppressive therapy is in a proliferative phase and therefore may be sensitive to the S-phase specific drug cytarabine. Based on this concept, 17 patients with refractory or relapsed leukemia or lymphoma undergoing either autologous or allogeneic bone marrow transplantation (BMT) were treated on a Phase I protocol using high doses of busulfan (16 mg/kg, days -10, -9, -8, -7) and cyclophosphamide (120 mg/kg, days -6, -5) followed by escalating doses of a 48-h continuous infusion of cytarabine (starting dose 1000 mg/m2/48 h, days -3, -2). Ten patients received autologous transplants (two with Hodgkin's disease, seven with non-Hodgkin's lymphoma, one with chronic myelogenous leukemia (CML) in blast phase). Seven received allogeneic BMT (two with refractory acute myelocytic leukemia (AML), one with refractory acute lymphoblastic leukemia (ALL) undergoing a second BMT, one with Burkitt's-type leukemia, one with ALL in fifth relapse and two with CML in accelerated/blast phase). Two of these patients received a T cell-depleted haploidentical transplant. The maximum tolerated dose of cytarabine was 1500 mg/m2/48 h; a pulmonary syndrome including dyspnea, hypoxemia, and interstitial infiltrates which responded to aggressive diuresis was the dose limiting toxicity. Of the 10 patients who received cytarabine doses of 2000 or 2500 mg/m2/48 h, five patients developed adult respiratory distress syndrome (ARDS) with three patients requiring intubation; two recovered. Of the nine patients with lymphoma, seven responded with complete tumor clearance (CTC) with two patients tumor-free 13 and 15 months post-BMT, one remained refractory and one died too early to evaluate (TETE).(ABSTRACT TRUNCATED AT 250 WORDS)

Does influenza vaccination exacerbate asthma?

A few anecdotal reports have described serious asthma exacerbations following influenza vaccination. However, a causal relationship has not been clearly established since the vaccine is administered at the time of year when the background incidence of asthma exacerbation is high. Some reports describing minor pulmonary function changes or increased bronchial reactivity in patients with asthma receiving influenza vaccination did not include placebo controls and the results as they are reported are difficult to interpret. Results from several placebo-controlled studies, open trials, and US and European postmarketing surveillance data have shown no evidence of asthma exacerbation related to killed influenza vaccination, although 1 recent placebo-controlled study demonstrated a decrease in peak flow in a small number of first-time vaccinees without clinical exacerbation of asthma. A recent report demonstrated that a group of children with acute asthma exacerbation tolerated influenza vaccination to the same degree as patients with stable asthma. Thus, a plethora of evidence indicates that killed-subunit influenza vaccination is well tolerated and does not exacerbate asthma to a clinically significant degree. Limited experience with live influenza vaccine also suggests that it may be safely given to patients with asthma. Although vaccine efficacy has not been unequivocally demonstrated in patients with asthma, the potential benefits from prevention of morbidity associated with influenza infection in these patients outweighs the theoretical concerns over the safety of influenza vaccination.

Appraisals of controllability and coping in caregivers and HIV+ men: testing the goodness-of-fit hypothesis.

The authors examined goodness of fit between controllability appraisals and coping in 82 HIV+ and 162 HIV-gay men experiencing the chronic stress of caregiving and 61 HIV+ gay men who were not caregiving. Multiple assessments of each individual over a 2-year period allowed replication of prior cross-sectional research examining goodness of fit, as well as the creation of intraindividual goodness-of-fit scores that were then used to examine within-person fluctuations in goodness of fit over time and goodness of fit as an individual difference variable related to adjustment. Results indicate that the importance of goodness of fit varies for different kinds of coping: The concept was supported for problem-focused coping and, to a lesser extent, for emotion-focused coping but not for meaning-focused coping. Within-subject variation in goodness of fit was related to within-subject variation in depressed mood, but between-subjects variation (individual differences) in fit was not associated with depressed mood, suggesting that goodness of fit is better understood as a transactional variable than as a personality or "coping style" variable.

The roles of constructive thinking and optimism in psychological and behavioral adjustment during pregnancy.

This study examined the impact of constructive thinking on the anxiety, positive states of mind, and substance use of 221 women during pregnancy and the influence of optimism and perceived stress on these relationships. Participants were interviewed both early and late in pregnancy. Constructive thinking predicted both psychological and behavioral adjustment later in pregnancy, independent of age and social desirability. Subsequent path analyses indicated that constructive thinking mediated the impact of optimism on anxiety, positive states of mind, and substance use during pregnancy. In turn, the effect of constructive thinking on women's adjustment during pregnancy was itself mediated by their perceived stress. Implications for constructive thinking and optimism as independent constructs relevant to adjustment and their potential importance for future research and clinical applications are discussed.

The impact of behavior and addiction on psychological models of cigarette and alcohol use during pregnancy.

This prospective study of 241 women investigated the impact of past behavior and psychological factors on cigarette and alcohol use during pregnancy. Smokers' cigarette use was compared with their alcohol consumption during pregnancy, and drinking among smokers was compared with that of nonsmokers. Only prior smoking directly predicted smokers' cigarette use later in pregnancy, whereas smokers' alcohol use was related to both their previous drinking and their drinking self-efficacy. Among nonsmokers, neither drinking before nor early in pregnancy was related to alcohol use later in pregnancy; only subjects' self-efficacy and their beliefs about the consequences of drinking during pregnancy predicted their subsequent alcohol use. These results are consistent with the notion that greater addictive potential lessens the direct impact of psychological factors on substance use during pregnancy. Further implications of these findings for interventions and other health-related behaviors are also discussed.

Stability and change in psychosocial resources during caregiving and bereavement in partners of men with AIDS.

This study examines the effects of caregiving and bereavement on psychosocial resources in HIV+ and HIV- caregivers of men with AIDS. We explored three hypotheses regarding these effects: the "wear and tear" hypothesis, which asserts that the chronic stress of caregiving and bereavement diminishes resources; the "enhancement" hypothesis, which asserts that caregiver resources may increase in response to increased demands; and the "personality" hypothesis, which asserts that psychosocial resources reflect stable personality characteristics. We addressed four questions: (a) What are the effects of caregiving on resources? (b) How do these resources vary by the imminence of the partner's death? (c) What is the effect of the partner's death on these resources? and (d) How does the caregivers' HIV serostatus influence the effects of caregiving and bereavement on resources? Support for the personality hypothesis predominated, with some support for the wear and tear hypothesis, depending on the resource in question. In general, HIV seropositivity did not put people at additional risk for resource depletion.

Transmission of human immunodeficiency virus from parents to only one dizygotic twin.

The acquired immunodeficiency syndrome-related complex was identified in a mother and one of her nonidentical twins. Generalized lymphadenopathy was first noted in the infant at age 17 months, and that of the mother was incidentally discovered 6 months later. The father, who had had homosexual contacts before the conception of the twins, appeared to be in good health. No one in the family had constitutional symptoms or showed signs of opportunistic infection. Both parents and the patient had hypergammaglobulinemia, low T-helper-to-suppressor-cell ratio, and positive serum antibody to human immunodeficiency virus. Attempts to isolate the virus from all family members were unsuccessful. The twin brother was in good health with a normal immunologic profile and negative antibody to human immunodeficiency virus.

Childhood common variable immunodeficiency with autoimmune disease.

Clinical and laboratory findings in eight patients with childhood common variable immunodeficiency and autoimmune disease are described. Six of the eight patients had initial signs of the disease, persistent secretory diarrhea, recurrent upper respiratory tract infections, or both, in the first year of life. Autoimmune manifestations included idiopathic thrombocytopenia (4/8), hemolytic anemia (3/8), secretory diarrhea (4/8), arthritis (2/8), chronic active hepatitis (2/8), parotitis (2/8), and Guillain-Barré syndrome (2/8). In addition to the expected sinusitis, otitis, and pneumonia caused by encapsulated bacteria, these patients also had severe infections with viruses of the herpes group. Most of these patients had lymphadenopathy, splenomegaly, growth failure, and failure to develop secondary sexual characteristics. Laboratory studies demonstrated a significant increase in the ratio of T cells expressing the T helper phenotype (OKT4) to T cells expressing the T suppressor-cytotoxic phenotype (OKT8) (T4/T8). This increase could be attributed to a decrease in the absolute number of T8 cells. Additional findings included fluctuating levels of serum immunoglobulins and markedly diminished in vitro antibody production by B cells. The clinical course was relapsing and remitting, and dominated by the autoimmune manifestations of the disease. This group of patients constitutes a distinct subset of children with hypogammaglobulinemia, a subset with a complex, multisystemic disorder associated with significant morbidity and mortality.

Temporal organization in children's strategy formation.

It is well established that children use study behaviors such as card sorting, category naming, and item-by-item rehearsal to assist subsequent word recall. In this article, we provide evidence that these behaviors are organized into coherent temporal patterns. Fourier analyses of individual behaviors over a sequence of five consecutive study/recall trials indicated that sorting was synchronized with the start of each trial, whereas rehearsal tended to occur later in each trial. Fourier analyses of pairs of behaviors indicated that sorting and category naming, both concerned with categorization of the to-be-remembered words, co-occurred early in each trial at a greater rate than expected based on their individual frequencies of occurrence (i.e., they were used cooperatively). In contrast, verbal rehearsal of individual words co-occurred with both sorting and category naming at a lesser rate than would be expected based on their individual frequencies of occurrence. The results thus point to a global strategy in which children learn the items' categories before they learn them individually. There was little apparent qualitative difference in temporal organization for second- and fourth-grade children. However, sorting early in each trial was more pronounced for children with better word recall (regardless of grade), and the suppressed co-occurrence of rehearsal with sorting and category naming (i.e., keeping category learning temporally separate from item learning) was more pronounced for the fourth-grade children.

Neuropeptide Y inhibits ciliary beat frequency in human ciliated cells via nPKC, independently of PKA.

The intracellular mechanisms whereby the inhibitory neurotransmitter neuropeptide Y (NPY) decreases ciliary beat frequency (CBF) were investigated in cultured human tracheal and bronchial ciliated cells. CBF was measured by nonstationary analysis laser light scattering. NPY at 1 and 10 microM decreased CBF from a baseline of 6.7 +/- 0.5 (n = 12) to 6.1 +/- 0.5 (P < 0.05) and 5.8 +/- 0.4 (P < 0.01) Hz, respectively. Prior application of PYX-1, an NPY antagonist, prevented the decreases of CBF induced by both doses of NPY. Two broad protein kinase C (PKC) kinase inhibitors, staurosporine and calphostin C, also abolished the NPY-induced decrease in CBF. The NPY-induced decrease in CBF was abolished by GF 109203X, a novel PKC (nPKC) isoform inhibitor, whereas this decrease in CBF was not attenuated by Gö-6976, a specific inhibitor of conventional PKC isoforms. Because pretreatment with NPY did not block the stimulation of CBF by forskolin and pretreatment with forskolin did not abolish the NPY-induced inhibition of CBF, this NPY receptor-mediated signal transduction mechanism appears to be independent of the adenylate cyclase-protein kinase A (PKA) pathway. Inhibition of Ca2+-ATPase by thapsigargin also prevented the suppression of CBF induced by subsequent application of NPY. These novel data indicate that, in cultured human epithelia, NPY decreases CBF below its basal level via the activation of an nPKC isoform and Ca2+-ATPase, independent of the activity of PKA. This is consistent with the proposition that NPY is an autonomic efferent inhibitory neurotransmitter regulating mucociliary transport.