While it is generally accepted that high job strain is associated with adverse occupational outcomes, the nature of this relationship and the causal pathways involved are not well elucidated. We ...aimed to assess the association between job strain and long-term sickness absence (LTSA), and investigate whether any associations could be explained by validated health measures.
Data from participants (n = 7346) of the Hordaland Health Study (HUSK), aged 40-47 at baseline, were analyzed using multivariate Cox regression to evaluate the association between job strain and LTSA over one year. Further analyses examined whether mental and physical health mediated any association between job strain and sickness absence.
A positive association was found between job strain and risk of a LTSA episode, even controlling for confounding factors (HR = 1.64 (1.36-1.98); high job strain exposure accounted for a small proportion of LTSA episodes (population attributable risk 0.068). Further adjustments for physical health and mental health individually attenuated, but could not fully explain the association. In the fully adjusted model, the association between high job strain and LTSA remained significant (HR = 1.30 (1.07-1.59)).
High job strain increases the risk of LTSA. While our results suggest that one in 15 cases of LTSA could be avoided if high job strain were eliminated, we also provide evidence against simplistic causal models. The impact of job strain on future LTSA could not be fully explained by impaired health at baseline, which suggests that factors besides ill health are important in explaining the link between job strain and sickness absence.
The alkaline stability of poly(arylene ether) backbones in anion exchange polymer electrolyte membranes (AEMs) derivatized with quaternary benzyl N, N- dimethylhexylammmonium (DMH+) and ...trimethylammonium (TMA+) cation groups were investigated in poly(2,6-dimethyl 1,4-phenylene) oxide (PPO) and Udel polysulfone (PSF) polymers. Previous studies have demonstrated that quaternary ammonium and phosphonium groups trigger backbone degradation in commercially available poly(arylene ether)-based AEMs, despite the base polymers being resilient to alkaline solutions. Herein, we demonstrate that the electron withdrawing or donating character in the poly(arylene ether) backbone ultimately decides whether or not the prepared AEMs will become brittle in alkaline media due to cation triggered backbone degradation. Mitigation of cation triggered backbone degradation was only achieved when electron withdrawing substituents (not including the cation), such as sulfone or bromine groups, were eliminated from the polymer backbone (or, alternately, when electron donating groups were present). Hence, PPO AEMs prepared through chloromethylation, as opposed to free radical bromination, were resistant to backbone hydrolysis in alkaline media because each cation-functionalized repeat unit had two electron donating methyl groups rather than a single methyl group. In summary, this paper presents some design rules for preparing mechanically stable poly(arylene ether) AEMs from low cost, commercially available polymers for alkaline electrochemical devices.
The spongy moth (Lymantria dispar) is a forest pest that damages a variety of trees in North America and Eurasia. A spongy moth outbreak occurred in part of South Korea in 2020 and caused severe ...damage to domestic forests and human society. Since the occurrence of spongy moths is influenced by climatic factors, this study examines the causes of spongy moth outbreaks by analyzing the temporal and spatial differences in climatic factors, influencing spongy moth occurrence using specimens collected during field surveys. Climatic factors were identified using global occurrence coordinates to compare the weather characteristics of spongy moth occurrence in domestic regions, using the kernel density function. Spatial and temporal comparisons were performed for monthly weather factors obtained from field surveys in 2020 and 2021 in areas with high and low spongy moth larvae densities. Spongy moth outbreaks may result from particular combinations of variable seasonality in temperature and precipitation, including high temperatures during cold periods and low precipitation during developmental periods.
On-demand deployment of small cells plays a key role in augmenting macro-cell coverage for outdoor hotspots, where user devices are brought together and intensively upload self-generated data. In ...this paper, we study spectrum sharing among rapidly deployable small cells in the uplink, even without a priori global knowledge. We propose a hybrid multi-agent approach, which allows a leading macro-cell base station (MBS) and multiple following small base stations (SBSs) to take part in a user-centric, online joint optimization of small cell deployment and uplink resource allocation. Specifically, we propose a centralized mechanism for the MBS to solve the first subproblem of small cell deployment stage by stage, based on an adversarial bandit model. Furthermore, we propose a distributed mechanism for the group of SBSs to collectively solve the second subproblem of uplink resource allocation stage by stage, based on a stochastic game model. We prove that our approach is guaranteed to produce a joint strategy, which is built upon a mixed strategy with bounded regret on the first tier and an equilibrium solution on the second tier. Our approach is validated by simulations on the aspects of convergence behavior, strategy correctness, power consumption, and spectral efficiency.
To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with chimeric antigen receptor (CAR) T-cell ...therapy.
A multidisciplinary panel of medical oncology, neurology, hematology, emergency medicine, nursing, trialists, and advocacy experts was convened to develop the guideline. Guideline development involved a systematic literature review and an informal consensus process. The systematic review focused on evidence published from 2017 to 2021.
The systematic review identified 35 eligible publications. Because of the paucity of high-quality evidence, recommendations are based on expert consensus.
The multidisciplinary team issued recommendations to aid in the recognition, workup, evaluation, and management of the most common CAR T-cell-related toxicities, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, B-cell aplasia, cytopenias, and infections. Management of short-term toxicities associated with CAR T cells begins with supportive care for most patients, but may require pharmacologic interventions for those without adequate response. Management of patients with prolonged or severe CAR T-cell-associated cytokine release syndrome includes treatment with tocilizumab with or without a corticosteroid. On the basis of the potential for rapid decline, patients with moderate to severe immune effector cell-associated neurotoxicity syndrome should be managed with corticosteroids and supportive care.Additional information is available at www.asco.org/supportive-care-guidelines.
The goal of this study was to compare health care costs, health care resource utilization, and adverse events associated with sustained oral corticosteroid (OCS) use versus no OCS use in systemic ...lupus erythematosus.
This retrospective cohort study used claims data (January 1, 2006–July 31, 2019) from patients with systemic lupus erythematosus aged ≥5 years with ≥24 months of continuous enrollment. Health care costs, health care resource utilization, and OCS-related adverse events were assessed. The sustained OCS cohort (defined as ≥12 months of continuous OCS use) was divided into exposure categories based on the number of 6-month classification periods with >5 mg/d OCS (0, 1–2, or 3–4).
Of the 6234 patients in the sustained OCS use cohort, there were 1587 (25.5%) patients with 0 periods of >5 mg/d OCS use, 2087 (33.5%) patients with 1 to 2 periods of >5 mg/d OCS use, and 2560 (41.1%) patients with 3 to 4 periods of >5 mg/d OCS use; the no OCS use cohort included 7828 patients. Adjusted health care cost differences (95% CIs) were significantly greater for patients with 0, 1 to 2, and 3 to 4 periods of OCS use >5 mg/d versus the no OCS use cohort ($7774 5426–10,223, $21,738 18,898–25,321, and $30,119 26,492–33,774, respectively). A higher proportion of patients in all OCS exposure categories required health care resource utilization (≥99.7% vs 93.4%) and experienced OCS-related adverse events (94.3%–96.8% vs 82.6%) versus the no OCS use cohort, with more periods of OCS use >5 mg/d associated with increased health care resource utilization and adverse events.
Sustained OCS use in systemic lupus erythematosus was associated with high economic burden, health care resource utilization, and OCS-related adverse events. These data highlight the need for health care providers to carefully consider OCS use in systemic lupus erythematosus.
Anoplophora glabripennis (Motschulsky) (Coleoptera: Cerambycidae) is a forest pest that damages a wide range of trees in areas where it has recently been introduced, demanding a proactive evaluation ...of its possible future distribution.
This study aimed to project the potential distribution of A. glabripennis using species distribution modelling and constructed an ensemble map for evaluating global risk areas.
We used CLIMEX and MaxEnt to evaluate the potential distribution of A. glabripennis as a function of current and future climates.
The results showed that the models predicted a high probability of A. glabripennis distribution where this species is currently found, and the suitable climate was shifted northward due to climate change.
The projected area differed between the models because of different modelling algorithm and climate change scenario; thus, an ensemble map projecting the consensus areas from two models was constructed to identify the risk areas that corresponded to the eastern United States, Europe, and native countries, Korea and China, and nearby Japan.
From the perspective of ensemble modelling for evaluating species distributions with reduced uncertainties, this study will enhance the model reliability for defining areas at risk of A. glabripennis occurrence.
Whereas genetic susceptibility increases the risk for major depressive disorder (MDD), non-genetic protective factors may mitigate this risk. In a large-scale prospective study of US Army soldiers, ...we examined whether trait resilience and/or unit cohesion could protect against the onset of MDD following combat deployment, even in soldiers at high polygenic risk.
Data were analyzed from 3079 soldiers of European ancestry assessed before and after their deployment to Afghanistan. Incident MDD was defined as no MDD episode at pre-deployment, followed by a MDD episode following deployment. Polygenic risk scores were constructed from a large-scale genome-wide association study of major depression. We first examined the main effects of the MDD PRS and each protective factor on incident MDD. We then tested the effects of each protective factor on incident MDD across strata of polygenic risk.
Polygenic risk showed a dose-response relationship to depression, such that soldiers at high polygenic risk had greatest odds for incident MDD. Both unit cohesion and trait resilience were prospectively associated with reduced risk for incident MDD. Notably, the protective effect of unit cohesion persisted even in soldiers at highest polygenic risk.
Polygenic risk was associated with new-onset MDD in deployed soldiers. However, unit cohesion - an index of perceived support and morale - was protective against incident MDD even among those at highest genetic risk, and may represent a potent target for promoting resilience in vulnerable soldiers. Findings illustrate the value of combining genomic and environmental data in a prospective design to identify robust protective factors for mental health.
Abstract
Background
Where head-to-head trials are lacking, indirect comparative effectiveness can aid treatment decisions. We conducted matching-adjusted indirect comparisons of clinical outcomes ...with filgotinib vs recently approved comparators (vedolizumab, tofacitinib, ustekinumab) in patients with moderately to severely active ulcerative colitis (UC).
Methods
Individual patient data from the SELECTION trial (NCT02914522) for filgotinib 200 mg were weighted to match average baseline characteristics of active treatment and placebo arms in comparator trials. Efficacy outcomes were compared for biologic-naive and biologic-experienced subgroups in induction and maintenance populations, if data were available. Safety and health-related quality of life outcomes were compared in the overall maintenance population.
Results
Filgotinib had a similar effect on efficacy outcomes compared with tofacitinib, ustekinumab, and subcutaneous vedolizumab in both the induction and maintenance populations. Filgotinib showed improved clinical response vs intravenous (IV) vedolizumab (odds ratio, 2.4; 95% confidence interval CI, 1.0 to 5.5; P < .05) among the biologic-experienced induction population, and improved corticosteroid-free clinical remission (odds ratio, 15.2; 95% CI, 1.6 to 139.9; P < .05) among the biologic-naive maintenance population. Improved efficacy outcomes were reported with filgotinib compared with ustekinumab among the maintenance population. Higher estimates of serious adverse events were reported for filgotinib compared with vedolizumab IV 300 mg and tofacitinib 5 mg; however, imbalances were noted in their placebo groups. Health-related quality of life outcomes were similar between filgotinib and comparators.
Conclusions
Matching-adjusted indirect comparison results suggest superiority of filgotinib 200 mg over vedolizumab IV in terms of clinical response and corticosteroid-free clinical remission in certain patient populations, noting small sample sizes and wide CIs, which may aid the selection of advanced therapies for moderately to severely active UC. A potential increased risk of serious adverse events was reported for filgotinib 200 mg vs vedolizumab IV and tofacitinib 5 mg, but findings should be interpreted with caution owing to underlying imbalances observed between the placebo groups of SELECTION and comparator trials.
Lay Summary
Matching-adjusted indirect comparisons between filgotinib and subcutaneous vedolizumab, tofacitinib, and ustekinumab demonstrated similar effects on efficacy, safety, and health-related quality of life in patients with ulcerative colitis. Clinical response and corticosteroid-free remission were improved with filgotinib compared with intravenous vedolizumab.
Purpose
Data on mental disorder prevalence and health service utilization required to inform healthcare management and planning are lacking in Hong Kong. The current study determined the prevalence ...of common mental disorders (CMD), and examined the patterns of mental health service utilization and associated factors.
Methods
We analyzed data from the Hong Kong Mental Morbidity Survey (HKMMS) of 5,719 Chinese adults aged 16–75 years in the general Hong Kong population, using the Chinese Revised Clinical Interview Schedule (CIS-R).
Results
The weighted prevalence estimate for any past-week CMD was 13.3 %, with mixed anxiety and depressive disorder being the most frequent diagnoses. CMD was positively associated with female gender, being divorced or separated, alcohol misuse, substance dependence, lack of regular physical exercise, and a family history of mental disorder. Among individuals with CMD, only 26 % had consulted mental health services in the past year; less than 10 % consulted general practitioners or family physicians. Lack of mental health service usage was significantly more likely in men and those with lower educational attainment.
Conclusions
Apart from attention to psychosocial risks, health and lifestyle factors are important considerations for mental health promotion. Service utilization for individuals with CMD in Hong Kong remains suboptimal, and would be enhanced by strengthening community primary care.
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