count 298Key words: Exercise, prostate cancer, quality of life, fatigue, adverse effects AbstractContext: Exercise for prostate cancer survivors could be beneficial. However, no systematic review across cancer stages and treatment types addressing potential benefits and harms exists to date.Objectives: Primarily, to assess the effects of exercise on cancer specific quality of life and adverse events in prostate cancer trials. Evidence acquisition:We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, SPORTDiscus and PEDro. We also searched grey literature databases, including trials registers. Searches were from database inception to March 2015.Standardised mean differences (SMD) were calculated for meta-analysis. Evidence synthesis:We included 16 RCTs involving 1574 men with prostate cancer. Follow-up varied from just eight weeks to 12months. RCTs involved men with stages I-IV cancers. High risk of bias was frequently due to attrition and intervention adherence. Seven trials involving 912 men measured cancer specific quality of life. No significant effect on this outcome was found from pooling the data from these seven trials (SMD = 0.13, 95% CI = -0.08, 0.34, median follow-up 12 weeks). Sensitivity analysis of studies that were judged to be of high quality indicated a moderate positive effect estimate (SMD = 0.33, 95% CI = 0.08, 0.58, median follow-up 12 weeks). Similar beneficial effects were seen in cancer specific fatigue, submaximal fitness and lower body strength. We found no evidence of benefit for disease progression, cardiovascular health or sexual function. There were no deaths attributable to exercise interventions. Other serious adverse events (e.g. myocardial infarction) were equivalent to those seen in controls. Conclusions:These results support exercise interventions for improving cancer specific quality of life, cancer specific fatigue, submaximal fitness and lower body strength.Patient summary: This review shows that exercise or physical activity interventions can improve quality of life, fatigue, fitness and function for men with prostate cancer. BackgroundProstate cancer is the primary cause of years lived with cancer disability in the Americas, North- hypercalcaemia, spinal cord compression, pathological fractures) can also adversely affect health. [7,8] Several recent systematic reviews have examined the effects of exercise in cancer survivors, in terms of quality of life outcome [9,10], exercise behaviour [11] and effects on fatigue.[12] These reviews are an amalgamation of heterogeneous primary cancers. Indeed, most evidence comes from trials in breast cancer and as such cannot be generalised to men with prostate cancer. Further, exercise therapy appears beneficial in the short term, but little is known about dose, duration and longerterm effects of such therapy, including adverse effects over an extended follow-up. Finally, despite the potential health benefits for men with prostate cancer, few clinicians are aware of the role of...

1 The depressant actions on evoked electrical activity and the excitant amino acid antagonist properties of a range of w-phosphonic x-carboxylic amino acids have been investigated in the isolated spinal cord preparations of the frog or immature rat. 2 When tested on dorsal root-evoked ventral root potentials, members of the homologous series from 2-amino-5-phosphonovaleric acid to 2-amino-8-phosphonooctanoic acid showed depressant actions which correlated with the ability of the substances to antagonize selectively motoneuronal depolarizations induced by N-methyl-D-aspartate. of this substance had a relatively weak and non-selective antagonist action on depolarizations induced by N-methyl-D-aspartate, quisqualate and kainate and a similarly weak depressant effect when tested on evoked electrical activity. The (+)-form was more potent than the (-)-form in depressing electrically evoked activity but did not antagonize responses to amino acid excitants. At concentrations higher than those required to depress electrically evoked activity, the (+)-form produced depolarization. This action was blocked by 2-amino-5-phosphonovalerate.

The results presented here suggest that the assumption of a universal 'deprivation amplification' hypothesis in studies of the neighbourhood food environment may be misguided. Associations between neighbourhood deprivation and grocery store accessibility vary by environmental setting. Theories and policies aimed at understanding and rectifying spatial inequalities in the distribution of neighbourhood exposures for poor diet need to be context specific.

BackgroundThe local retail food environment around schools may act as a potential risk factor for adolescent diet. However, international research utilising cross-sectional designs to investigate associations between retail food outlet proximity to schools and diet provides equivocal support for an effect. In this study we employ longitudinal perspectives in order to answer the following two questions. First, how has the local retail food environment around secondary schools changed over time and second, is this change associated with change in diet of students at these schools?MethodsThe locations of retail food outlets and schools in 2001 and 2005 were geo-coded in three London boroughs. Network analysis in a Geographic Information System (GIS) ascertained the number, minimum and median distances to food outlets within 400 m and 800 m of the school location. Outcome measures were ‘healthy’ and ‘unhealthy’ diet scores derived from adolescent self-reported data in the Research with East London Adolescents: Community Health Survey (RELACHS). Adjusted associations between distance from school to food retail outlets, counts of outlets near schools and diet scores were assessed using longitudinal (2001–2005 n=757) approaches.ResultsBetween 2001 and 2005 the number of takeaways and grocers/convenience stores within 400 m of schools increased, with many more grocers reported within 800 m of schools in 2005 (p< 0.001). Longitudinal analyses showed a decrease of the mean healthy (−1.12, se 0.12) and unhealthy (−0.48, se 0.16) diet scores. There were significant positive relationships between the distances travelled to grocers and healthy diet scores though effects were very small (0.003, 95%CI 0.001 – 0.006). Significant negative relationships between proximity to takeaways and unhealthy diet scores also resulted in small parameter estimates.ConclusionsThe results provide some evidence that the local food environment around secondary schools may influence adolescent diet, though effects were small. Further research on adolescents’ food purchasing habits with larger samples in varied geographic regions is required to identify robust relationships between proximity and diet, as small numbers, because of confounding, may dilute effect food environment effects. Data on individual foods purchased in all shop formats may clarify the frequent, overly simple classification of grocers as ‘healthy’.

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BackgroundPatients are increasingly rating their family physicians on the Internet in the same way as they might rate a hotel on TripAdvisor or a seller on eBay, despite physicians’ concerns about this process.ObjectiveThis study aims to examine the usage of NHS Choices, a government website that encourages patients to rate the quality of family practices in England, and associations between web-based patient ratings and conventional measures of patient experience and clinical quality in primary care.MethodsWe obtained all (16,952) ratings of family practices posted on NHS Choices between October 2009 and December 2010. We examined associations between patient ratings and family practice and population characteristics. Associations between ratings and survey measures of patient experience and clinical outcomes were examined.Results61% of the 8089 family practices in England were rated, and 69% of ratings would recommend their family practice. Practices serving younger, less deprived, and more densely populated areas were more likely to be rated. There were moderate associations with survey measures of patient experience (Spearman ρ 0.37−0.48, P<.001 for all 5 variables), but only weak associations with measures of clinical process and outcome (Spearman ρ less than ±0.18, P<.001 for 6 of 7 variables).ConclusionThe frequency of patients rating their family physicians on the Internet is variable in England, but the ratings are generally positive and are moderately associated with other measures of patient experience and weakly associated with clinical quality. Although potentially flawed, patient ratings on the Internet may provide an opportunity for organizational learning and, as it becomes more common, another lens to look at the quality of primary care.

In the UK, food poverty has been associated with conditions such as obesity, malnutrition, hypertension, iron deficiency, and impaired liver function. Food banks, the primary response to food poverty on the ground, typically rely on community referral and distribution systems that involve health and social care professionals and local authority public health teams. The perspectives of these key stakeholders remain underexplored. This paper reports on a qualitative study of the health and wellbeing challenges of food poverty and food banking in London. An ethnographic investigation of food bank staff and users was carried out alongside a series of healthcare stakeholder interviews. A total of 42 participants were interviewed. A Critical Grounded Theory (CGT) analysis revealed that contemporary lived experiences of food poverty are embedded within and symptomatic of extreme marginalisation, which in turn impacts upon health. Specifically, food poverty was conceptualised by participants to: firstly, be a barrier to providing adequate care and nutrition for young children; secondly, be exacerbated by lack of access to adequate fresh food, food storage and cooking facilities; and thirdly, amplify existing health and social problems. Further investigation of the local government structures and professional roles that both rely upon and serve to further embed the food banking system is necessary in order to understand the politics of changing welfare landscapes.

BackgroundNational guidelines (NICE-CG175) recommended 12 weeks of supervised exercise training for men treated with androgen deprivation therapy (ADT) for prostate cancer to counter debilitating adverse effects of castration. As with other chronic conditions where exercise is indicated, it is uncertain if these services are being delivered in the health services. The aim of this multi-centre investigation was to examine what exercise referral is currently available for men on ADT as provided by the NHS and if a supervised, individually-tailored exercise training package (as per the national NICE guidelines CG175) is embedded within prostate cancer care.MethodsA multi-centre investigation of current National Health Service (NHS) care involving a web-based survey of NHS prostate cancer care, five focus groups involving 26 men on ADT and 37 semi-structured interviews with healthcare professionals (HCPs) involved in the management of prostate cancer. Descriptive statistics and thematic analysis evaluated quantitative and qualitative data, respectively. Qualitative methods followed COREQ standards.ResultsHCPs and men on ADT asserted that medical castration has a serious and debilitating impact on many features of men's quality of life. There is support for exercise training programmes as part of cancer care and patients would support their initiation soon after diagnosis. Involving the Multidisciplinary Team (MDT) is proposed as key to this. Critically, traditional values in oncology would need to be overcome for widespread acceptance. Specialist further training for HCPs around behaviour change support could encourage this. Given that these schemes are seen as a fundamental part of cancer care, it is felt the NHS should commission and support provision. 79 representatives of 154 NHS trusts (51%) provided survey data on current delivery: only 17% could provide supervised exercise as per CG175.ConclusionsEvidence-based national exercise guidelines are not being delivered to men on ADT as intended. Traditional values in oncology and the need for NHS financial support are seen as major barriers to provision of current best practice guidelines. Despite this both HCPs and men on ADT are in favour of such programmes being a fundamental part of their cancer care.