Uptake of treat-to-target (TTT) strategies for rheumatoid arthritis (RA) management is low. Our objective was to understand the heterogeneity in patients' conceptualisation of RA treatment to inform ...interventions improving TTT uptake.
Eligible participants recruited from an online research registry rated 56 items (on 5-point scales) reflecting concepts raised from patient interviews. Using items describing adhering to physician recommendations to create a binary criterion variable for medication adherence, we conducted a principal components analysis on the remaining items using Varimax rotation, describing how these factors predict adherence over and above demographic characteristics. We further use optimal sets in regression to identify the individual concepts that are most predictive of medication adherence.
We found significant heterogeneity in patients' conceptualisation of RA treatment among 621 persons with RA. A scree plot revealed a four-factor solution explained 38.4% of the variance. The four factors expected to facilitate TTT uptake were (% variance explained): (1) Access to high quality care and support (11.3%); (2) low decisional conflict related to changing disease-modifying antirheumatic drugs (DMARDs) (10.1%); (3) endorsement of a favourable DMARD risk/benefit ratio (9.9%); and (4) confidence that testing reflects disease activity (7.2%). These factors account for 13.8% of the variance in full medication adherence, fully explaining the only significant demographic predictor, age of the patient. The individual items most predictive of poor adherence centre on the lack of effective patient-physician communication, specifically insufficient access to information from rheumatologists, along with the need to seek information elsewhere.
Patients' conceptualisation of RA treatment varies; however, almost all patients have difficulty escalating DMARDs, even with access to quality information and an understanding of the benefits of TTT. Tailored interventions are needed to address patient hesitancy to escalate DMARDs.
In practice the secondary prevention of work-related upper extremity (WRUE) symptoms generally targets biomechanical risk factors. Psychosocial risk factors have also been shown to play an important ...role in the development of WRUE symptom severity and future disability. The addition of a stress management component to biomechanically focused interventions may result in greater improvements in WRUE symptoms and functional limitations than intervening in the biomechanical risk factors alone. Seventy office workers with WRUE symptoms were randomly assigned to an ergonomics intervention group (assessment and modification of work station and stretching exercises) or a combined ergonomic and job stress intervention group (ergonomic intervention plus two 1-h workshops on the identification and management of workplace stress). Baseline, 3- and 12-month follow-up measures of observed ergonomic risks and self-reported ergonomic risks, job stress, pain, symptoms, functional limitation, and general physical and mental health were obtained from all participants. While both groups experienced significant decreases in pain, symptoms, and functional limitation from baseline to three months with improvements continuing to 12 months post baseline, no significant differences between groups were observed for any outcome measures. Findings indicate that the additional two-session job stress management component did not significantly enhance the short- or long-term improvements brought about by the ergonomic intervention alone.
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease (COVID-19) has resulted in roughly 500 million confirmed cases of COVID-19 including an ...estimated 6 million deaths world-wide, as of April 2022. Vaccines were developed and administered limiting the extent of the pandemic, but with the rise of emerging variants, studies to better understand immune protection against COVID-19 have become a high priority. Neutralizing antibodies represent an important correlate of protection for COVID-19. The cell-based neutralization assays that detect and quantify neutralizing antibody titers use either live virus or pseudotyped viral particles (pseudovirus). Live virus cell-based assays are time consuming and require the use of live SARS-CoV-2 but can be substituted with pseudovirus to avoid requirements for biosafety level (BSL)-3 facilities. This has motivated the development of surrogate SARS-CoV-2 neutralization assays that measure inhibition of the spike (S) protein receptor binding domain (RBD) binding its receptor, human angiotensin converting enzyme 2 (hACE2). The current surrogate virus neutralization tests (sVNTs) are ELISA-based, requiring considerable involvement by laboratory personnel for the multiple washes, incubation steps, and reagent additions as well as a plate reader to generate results. The development of a sVNT performed on an automated and rapid platform could be instrumental in furthering the research and clinical assessment of immune protection against COVID-19. Here we developed and evaluated a sVNT performed on the Simple PlexTM rapid and automated immunoassay platform. The test achieves 100% sensitivity and 99-100% specificity and shows a strong correlation with cell-based assays. This rapid and automated sVNT provides a faster and more easily completed assay for determining SARS-CoV-2 neutralizing antibody titers that can be performed in a BSL-2 laboratory.
Office work-related upper extremity symptoms and disorders have been associated with static work posture, repetition, and inadequate recovery in the anatomic structures of the neck and upper ...extremities. Despite these associations, relatively little research has been conducted on the development of practical measures of these ergonomic exposures. The present study examines the measurement properties of an upper-extremity-specific self-report index of ergonomic exposures. Ninety-two symptomatic office workers completed a Web-based questionnaire measuring demographic variables, ergonomic exposures, pain, job stress, and functional limitations. Comparisons of internal consistency, construct validity, and discriminative and predictive abilities were made between the self report index and an observational exposure assessment checklist. Results indicated that the selfreport index had acceptable measurement properties. Furthermore, higher levels of self-reported ergonomic exposures were associated with upper extremity pain, symptom severity, and functional limitations. In contrast, higher levels of observed exposure were only to lower levels of general physical function. The self-report measure has potential for use in occupational health surveilance programs for office work environments and as an outcome measure of ergonomic exposure in intervention trials. These results also suggest the need for using multiple methods when assessing ergonomic exposures.
Associations between selected sites of musculoskeletal discomfort and ergonomic characteristics of the video display terminal (VDT) workstation were assessed in analyses controlling for demographic, ...psychosocial stress, and VDT use factors in 273 VDT users from a large administrative department. Significant associations with wrist/hand discomfort were seen for female gender; working 7+ hours at a VDT; low job satisfaction; poor keyboard position; use of new, adjustable furniture; and layout of the workstation. Significantly increased odds ratios for neck/shoulder discomfort were observed for 7+ hours at a VDT, less than complete job control, older age (40 to 49 years), and never/infrequent breaks. Lower back discomfort was related marginally to working 7+ hours at a VDT. These results demonstrate that some characteristics of VDT workstations, after accounting for psychosocial stress, can be correlated with musculoskeletal discomfort.
The effects of an ergonomic intervention on musculoskeletal discomfort in 118 video display terminal (VDT) users were assessed 1 year after intervention. The intervention consisted of recommended ...changes to workstations, which were based on the evaluation of 15 ergonomic characteristics. Compliance with the intervention was at least 75% for most workstation characteristics. Reduction in discomfort was substantial and was highest for the wrist/hand (57%), lower back (43%), and neck/shoulder (41%) seventy of discomfort outcomes. Neither compliance with intervention on individual workstation characteristics nor summary intervention scores were associated with reduction in discomfort. Our results demonstrate that although reduction of musculoskeletal discomfort may be observed in the context of an intervention study, it may be difficult to link these benefits to specific interventions.
"La diarrea causa mas enfermedades que cualquier otra dolencia", indica el informe. "Los ninos que sobreviven a la diarrea persistente son mas proclives a sufrir desnutricion, problemas de ...crecimiento y dificultades de aprendizaje." El informe de WaterAid, titulado "Fatal Neglect: How Health Systems are Failing to Comprehensibly Address Child Mortality" ("Negligencia fatal: Como los sistemas de salud fracasan en el intento de atender exhaustivamente la mortalidad infantil"), considera que la falta de atencion es "sintoma de un problema mas amplio". "El sistema de asistencia debe dar una mejor respuesta al asignar recursos donde son mas necesarios", incluidos los paises donde hay gran presencia de "diarrea causada por mal saneamiento", indica.
Gestational stress can increase postpartum depression in women. To treat maternal depression, fluoxetine (FLX) is most commonly prescribed. While FLX may be effective for the mother, at high doses it ...may have adverse effects on the fetus. As environmental enrichment (EE) can reduce maternal stress effects, we hypothesized that a subthreshold dose of FLX increases the impact of EE to reduce anxiety and depression-like behavior in postpartum dams exposed to gestational stress. We evaluated this hypothesis in mice and to assess underlying mechanisms we additionally measured hypothalamic-pituitary-adrenal (HPA) axis function and brain levels of the hormone oxytocin, which are thought to be implicated in postpartum depression. Gestational stress increased anxiety- and depression-like behavior in postpartum dams. This was accompanied by an increase in HPA axis function and a decrease in whole-brain oxytocin levels in dams. A combination of FLX and EE remediated the behavioral, HPA axis and oxytocin changes induced by gestational stress. Central administration of an oxytocin receptor antagonist prevented the remediating effect of FLX + EE, indicating that brain oxytocin contributes to the effect of FLX + EE. These findings suggest that oxytocin is causally involved in FLX + EE mediated remediation of postpartum stress-related behaviors, and HPA axis function in postpartum dams.
A subanesthetic dose of ketamine causes acute psychotomimetic symptoms and sustained antidepressant effects. In prefrontal cortex, the prevailing disinhibition hypothesis posits that ...N-methyl-d-aspartate receptor (NMDAR) antagonists such as ketamine act preferentially on GABAergic neurons. However, cortical interneurons are heterogeneous. In particular, somatostatin-expressing (SST) interneurons selectively inhibit dendrites and regulate synaptic inputs, yet their response to systemic NMDAR antagonism is unknown. Here, we report that ketamine acutely suppresses the activity of SST interneurons in the medial prefrontal cortex of the awake mouse. The deficient dendritic inhibition leads to greater synaptically evoked calcium transients in the apical dendritic spines of pyramidal neurons. By manipulating NMDAR signaling via GluN2B knockdown, we show that ketamine's actions on the dendritic inhibitory mechanism has ramifications for frontal cortex-dependent behaviors and cortico-cortical connectivity. Collectively, these results demonstrate dendritic disinhibition and elevated calcium levels in dendritic spines as important local-circuit alterations driven by the administration of subanesthetic ketamine.
Prior research demonstrates gender differences in language used in letters of recommendation. The emergency medicine (EM) Standardized Letter of Evaluation (SLOE) format limits word count and ...provides detailed instructions for writers. The objective of this study is to examine differences in language used to describe men and women applicants within the SLOE narrative.
All applicants to a four-year academic EM residency program within a single application year with a first rotation SLOE available were included in the sample. We used the Linguistic Inquiry and Word Count (LIWC) program to analyze word frequency within 16 categories. Descriptive statistics, chi-squared, and t-tests were used to describe the sample; gender differences in word frequency were tested for using Mann-Whitney U tests.
Of 1117 applicants to the residency program, 822 (82%) first-rotation SLOEs were available; 64% were men, and 36% were women. We did not find a difference in baseline characteristics including age (mean 27 years), top 25 schools (22.5%), Alpha Omega Alpha Honor Medical Society rates (13%), and having earned advanced degrees (10%). The median word count per SLOE narrative for men was 171 and for women was 180 (p = 0.15). After adjusting for letter length, word frequency differences between genders were only present in two categories: social words (women: 23 words/letter; men: 21 words/letter, p = 0.02) and ability words (women: 2 words/letter; men: 1 word/letter, p = 0.04). We were unable to detect a statistical difference between men and women applicants in the remaining categories, including words representing communal traits, agentic traits, standout adjectives, grindstone traits, teaching words, and research words.
The small wording differences between genders noted in two categories were statistically significant, but of unclear real-world significance. Future work is planned to evaluate how the SLOE format may contribute to this relative lack of bias compared to other fields and formats.
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