The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were 'expert opinion'.
A ...multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations.
2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only 'strong for' therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as 'weak for' based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability).
These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.
ObjectivesThere is little consensus regarding the burden of pain in the UK. The purpose of this review was to synthesise existing data on the prevalence of various chronic pain phenotypes in order to ...produce accurate and contemporary national estimates.DesignMajor electronic databases were searched for articles published after 1990, reporting population-based prevalence estimates of chronic pain (pain lasting >3 months), chronic widespread pain, fibromyalgia and chronic neuropathic pain. Pooled prevalence estimates were calculated for chronic pain and chronic widespread pain.ResultsOf the 1737 articles generated through our searches, 19 studies matched our inclusion criteria, presenting data from 139 933 adult residents of the UK. The prevalence of chronic pain, derived from 7 studies, ranged from 35.0% to 51.3% (pooled estimate 43.5%, 95% CIs 38.4% to 48.6%). The prevalence of moderate-severely disabling chronic pain (Von Korff grades III/IV), based on 4 studies, ranged from 10.4% to 14.3%. 12 studies stratified chronic pain prevalence by age group, demonstrating a trend towards increasing prevalence with increasing age from 14.3% in 18–25 years old, to 62% in the over 75 age group, although the prevalence of chronic pain in young people (18–39 years old) may be as high as 30%. Reported prevalence estimates were summarised for chronic widespread pain (pooled estimate 14.2%, 95% CI 12.3% to 16.1%; 5 studies), chronic neuropathic pain (8.2% to 8.9%; 2 studies) and fibromyalgia (5.4%; 1 study). Chronic pain was more common in female than male participants, across all measured phenotypes.ConclusionsChronic pain affects between one-third and one-half of the population of the UK, corresponding to just under 28 million adults, based on data from the best available published studies. This figure is likely to increase further in line with an ageing population.
Global prevalence of ankylosing spondylitis Dean, Linda E; Jones, Gareth T; MacDonald, Alan G ...
Rheumatology (Oxford, England),
04/2014, Letnik:
53, Številka:
4
Journal Article
Recenzirano
Odprti dostop
For effective health care provision, knowledge of disease prevalence is paramount. There has been no systematic endeavour to establish continent-based AS estimates, however, prevalence is thought to ...vary by country and background HLA-B27 prevalence. This study aimed to estimate AS prevalence worldwide and to calculate the expected number of cases.
A systematic literature search was conducted. Prevalence data were extracted and used to calculate the mean prevalence by continent and the expected number of cases based on country-specific prevalence (or, if missing, the prevalence from neighbouring countries). A second estimate was made using the prevalence from countries with similar HLA-B27 prevalences if a country-specific prevalence estimate was not available.
The mean AS prevalence per 10,000 (from 36 eligible studies) was 23.8 in Europe, 16.7 in Asia, 31.9 in North America, 10.2 in Latin America and 7.4 in Africa. Additional estimates, weighted by study size, were calculated as 18.6, 18.0 and 12.2 for Europe, Asia and Latin America, respectively. There were sufficient studies to estimate the number of cases in Europe and Asia, calculated to be 1.30-1.56 million and 4.63-4.98 million, respectively.
This study represents the first systematic attempt to collate estimates of AS prevalence into a single continent-based estimate. In addition, the number of expected cases in Europe and Asia was estimated. Through reviewing the current literature, it is apparent that the continuing conduct of epidemiological studies of AS prevalence is of great importance, particularly as diagnostic capabilities improve and with the recent development of the criteria for axial SpA.
Torrefaction is a treatment which serves to improve the properties of biomass in relation to thermochemical processing techniques for energy generation; for example, combustion, co-combustion with ...coal or gasification. The topic has gathered interest in the past two decades but further understanding is required for optimisation of the process thus enhancing economic efficiency, which is crucial to the success of the treatment commercially and within industry. In particular there is a noticeable gap in current literature regarding the combustion properties of torrefied biomass. This study examines torrefaction in nitrogen of two energy crops, reed canary grass and short rotation willow coppice (SRC), and a residue, wheat straw. Product evolution and mass and energy losses during torrefaction are measured using a range of laboratory scale methods. Experiments at different torrefaction conditions were undertaken to examine optimization of the process for the three fuels. Progress of torrefaction was also followed by chemical analysis (C, H, N, O, ash), and it was seen that the characters of the biomass fuels begin to resemble those of low rank coals in terms of the van Krevelen coal rank parameter. In addition, the results indicate that the volatile component of biomass is both reduced and altered producing a more thermally stable product, but also one that produces greater heats of reaction during combustion. The difference between the mass and energy yield was shown to improve for the higher torrefaction temperatures investigated. The combustion behaviour of raw and torrefied fuels was studied further by differential thermal analysis (DTA) and also, for willow, by suspending individual particles in a methane–air flame and following the progress of combustion by high-speed video. It is shown that both volatile and char combustion of the torrefied sample become more exothermic compared to the raw fuels, and that depending on the severity of the torrefaction conditions, the torrefied fuel can contain up to 96% of the original energy content on a mass basis. Upon exposure to a methane-air flame, torrefied willow ignites more quickly, presumably because its low moisture content means that it heats faster. Torrefied particles also begin char combustion quicker than the raw SRC particles, although char combustion is slower for the torrefied fuel.
Objective To determine the risk of recurrent stillbirth.Design Systematic review and meta-analysis of cohort and case-control studies.Data sources Embase, Medline, Cochrane Library, PubMed, CINAHL, ...and Scopus searched systematically with no restrictions on date, publication, or language to identify relevant studies. Supplementary efforts included searching relevant internet resources as well as hand searching the reference lists of included studies. Where published information was unclear or inadequate, corresponding authors were contacted for more information.Study selection Cohort and case-control studies from high income countries were potentially eligible if they investigated the association between stillbirth in an initial pregnancy and risk of stillbirth in a subsequent pregnancy. Stillbirth was defined as fetal death occurring at more than 20 weeks’ gestation or a birth weight of at least 400 g. Two reviewers independently screened titles to identify eligible studies based on inclusion and exclusion criteria agreed a priori, extracted data, and assessed the methodological quality using scoring criteria from the critical appraisal skills programme. Random effects meta-analyses were used to combine the results of the included studies. Subgroup analysis was performed on studies that examined unexplained stillbirth.Results 13 cohort studies and three case-control studies met the inclusion criteria and were included in the meta-analysis. Data were available on 3 412 079 women with pregnancies beyond 20 weeks duration, of who 3 387 538 (99.3%) had had a previous live birth and 24 541 (0.7%) a stillbirth. A total of 14 283 stillbirths occurred in subsequent pregnancies, 606/24 541 (2.5%) in women with a history of stillbirth and 13 677/3 387 538 (0.4%) among women with no such history (pooled odds ratio 4.83, 95% confidence interval 3.77 to 6.18). 12 studies specifically assessed the risk of stillbirth in second pregnancies. Compared with women who had a live birth in their first pregnancy, those who experienced a stillbirth were almost five times more likely to experience a stillbirth in their second pregnancy (odds ratio 4.77, 95% confidence interval 3.70 to 6.15). The pooled odds ratio using the adjusted effect measures from the primary studies was 3.38 (95% confidence interval 2.61 to 4.38). Four studies examined the risk of recurrent unexplained stillbirth. Methodological differences between these studies precluded pooling the results.Conclusions The risk of stillbirth in subsequent pregnancies is higher in women who experience a stillbirth in their first pregnancy. This increased risk remained after adjusted analysis. Evidence surrounding the recurrence risk of unexplained stillbirth remains controversial.
It has been estimated that over 80% of the population will report low back pain (LBP) at some point in life,1 and each year 7% of the adult population consult their GP with symptoms.2 Prevalence ...increases with age, reaching a peak during the sixth decade of life.3 Until recently little was known about LBP at young ages. Clinically it was perceived to be uncommon—with few children consulting because of LBP in primary care. Large prospective epidemiological studies have shown that, in those free of LBP at baseline, the best predictor of future onset is a previous history of LBP.4 Therefore, to understand the epidemiology of LBP, and what predisposes someone to a trajectory of LBP in adult life, it is important to examine the condition at young ages, to determine factors responsible for onset of initial episodes, and to examine whether LBP in childhood is related to symptoms in adulthood.
Little is known about adherence to inhaled medication in chronic obstructive pulmonary disease (COPD) and the impact on mortality and morbidity.
Data on drug adherence from a randomised double-blind ...trial comparing inhaled salmeterol 50 microg + fluticasone propionate 500 microg twice daily with placebo and each drug individually in 6112 patients with moderate to severe COPD over 3 years in the TORCH study were used. All-cause mortality and exacerbations leading to hospital admission were primary and secondary end points. The study of adherence was not specified a priori as an ancillary study.
Of the 4880 patients (79.8%) with good adherence defined as >80% use of study medication, 11.3% died compared with 26.4% of the 1232 patients (20.2%) with poor adherence. The annual rates of hospital admission for exacerbations were 0.15 and 0.27, respectively. The association between adherence and mortality remained unchanged and statistically significant after adjusting for other factors related to prognosis (hazard ratio 0.40 (95% CI 0.35 to 0.46), p<0.001). The association was even stronger when analysing on-treatment deaths only. Similarly, the association between adherence and hospital admission remained unchanged and significant in a multivariate analysis (rate ratio 0.58 (95% CI 0.44 to 0.73, p<0.001). The association between increased adherence and improved mortality and reduction in hospital admission was independent of study treatment. The effect of treatment was more pronounced in patients with good adherence than in those with poor adherence.
Adherence to inhaled medication is significantly associated with reduced risk of death and admission to hospital due to exacerbations in COPD. Further research is needed to understand these strong associations.
This randomized, controlled, multicenter, open-label, phase III study compared docetaxel versus paclitaxel in patients with advanced breast cancer that had progressed after an ...anthracycline-containing chemotherapy regimen.
Patients (n = 449) were randomly assigned to receive either docetaxel 100 mg/m2 (n = 225) or paclitaxel 175 mg/m2 (n = 224) on day 1, every 21 days until tumor progression, unacceptable toxicity, or withdrawal of consent.
In the intent-to-treat population, both the median overall survival (OS, 15.4 v 12.7 months; hazard ratio HR, 1.41; 95% CI, 1.15 to 1.73; P = .03) and the median time to progression (TTP, 5.7 months v 3.6 months; HR, 1.64; 95% CI, 1.33 to 2.02; P < .0001) for docetaxel were significantly longer than for paclitaxel, and the overall response rate (ORR, 32% v 25%; P = .10) was higher for docetaxel. These results were confirmed by multivariate analyses. The incidence of treatment-related hematologic and nonhematologic toxicities was greater for docetaxel than for paclitaxel; however, quality-of-life scores were not statistically different between treatment groups over time.
Docetaxel was superior to paclitaxel in terms of OS and TTP. ORR was higher for docetaxel. Hematologic and nonhematologic toxicities occurred more frequently in the docetaxel group. The global quality-of-life scores were similar for both agents over time.
Inhaled corticosteroids (ICS) are important in reducing exacerbation frequency associated with chronic obstructive pulmonary disease (COPD). However, little is known about the risk of associated ...infections. In a post hoc analysis of the TOwards a Revolution in COPD Health (TORCH) study, we analysed and identified potential risk factors for adverse event reports of pneumonia in this randomised, double-blind trial comparing twice-daily inhaled salmeterol (SAL) 50 microg, fluticasone propionate (FP) 500 microg, and the combination (SFC) with placebo in 6,184 patients with moderate-to-severe COPD over 3 yrs. Despite a higher withdrawal rate in the placebo arm, after adjusting for time on treatment, a greater rate of pneumonia was reported in the FP and SFC treatment arms (84 and 88 per 1,000 treatment-yrs, respectively) compared with SAL and placebo (52 and 52 per 1,000 treatment-yrs, respectively). Risk factors for pneumonia were age > or =55 yrs, forced expiratory volume in 1 s <50% predicted, COPD exacerbations in the year prior to the study, worse Medical Research Council dyspnoea scores and body mass index <25 kg.m(-2). No increase in pneumonia deaths with SFC was observed; this could not be concluded for FP. Despite the benefits of ICS-containing regimens in COPD management, healthcare providers should remain vigilant regarding the possible development of pneumonia as a complication in COPD patients receiving such therapies.
The process of torrefaction alters the physical properties of biomass, reducing its fibrous tenacious nature. This could allow increased rates of co-milling and therefore co-firing in coal fired ...power stations, which in turn would enable a reduction in the amount of coal used and an increase in the use of sustainable fuels, without the need for additional plant. This paper presents an experimental investigation of the pulverisation behaviour of two torrefied energy crops, namely: willow and Miscanthus. A multifactorial method approach was adopted to investigate the three process parameters of temperature, residence time and particle size, producing fuels treated using four different torrefaction conditions. The untreated and torrefied fuels were subjected to standard fuel analysis techniques including ultimate analysis, proximate analysis and calorific value determination. The grindability of these fuels was then determined using a laboratory ball mill and by adapting the Hardgrove Grindability Index (HGI) test for hard coals. After grinding, two sets of results were obtained. Firstly a determination similar to the HGI test was made, measuring the proportion of sample passing through a 75
μm sieve and plotting this on a calibrated HGI chart determined using four standard reference coals of known HGI values. Secondly the particle size distributions of the entire ground sample were measured and compared with the four standard reference coals. The standard fuel tests revealed that temperature was the most significant parameter in terms of mass loss, changes in elemental composition and energy content increase. The first grindability test results found that the untreated fuels and fuels treated at low temperatures showed very poor grindability behaviour. However, more severe torrefaction conditions caused the fuels to exhibit similar pulverisation properties as coals with low HGI values. Miscanthus was found to have a higher HGI value than willow. On examining the particle size distributions it was found that the particle size distributions of torrefied Miscanthus differed significantly from the untreated biomass and had comparable profiles to those of the standard reference coals with which they had similar HGI values. However, only the torrefied willow produced at the most severe conditions investigated exhibited this behaviour, and the HGI of torrefied willow was not generally a reliable indicator of grindability performance for this energy crop. Overall it was concluded that torrefied biomass can be successfully pulverised and that torrefied Miscanthus was easier to grind than torrefied willow.
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