The worldwide epidemic of obesity has brought considerable attention to research aimed at understanding the biology of adipocytes (fat cells) and the events occurring in adipose tissue (fat) and in ...the bodies of obese individuals. Accumulating evidence indicates that obesity causes chronic low-grade inflammation and that this contributes to systemic metabolic dysfunction that is associated with obesity-linked disorders. Adipose tissue functions as a key endocrine organ by releasing multiple bioactive substances, known as adipose-derived secreted factors or adipokines, that have pro-inflammatory or anti-inflammatory activities. Dysregulated production or secretion of these adipokines owing to adipose tissue dysfunction can contribute to the pathogenesis of obesity-linked complications. In this Review, we focus on the role of adipokines in inflammatory responses and discuss their potential as regulators of metabolic function.
Background
This is the second update of a Cochrane Review (Issue 4, 2006). Pain and distress from needle‐related procedures are common during childhood and can be reduced through use of psychological ...interventions (cognitive or behavioral strategies, or both). Our first review update (Issue 10, 2013) showed efficacy of distraction and hypnosis for needle‐related pain and distress in children and adolescents.
Objectives
To assess the efficacy of psychological interventions for needle‐related procedural pain and distress in children and adolescents.
Search methods
We searched six electronic databases for relevant trials: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; PsycINFO; Embase; Web of Science (ISI Web of Knowledge); and Cumulative Index to Nursing and Allied Health Literature (CINAHL). We sent requests for additional studies to pediatric pain and child health electronic listservs. We also searched registries for relevant completed trials: clinicaltrials.gov; and World Health Organization International Clinical Trials Registry Platform (www.who.int.trialsearch). We conducted searches up to September 2017 to identify records published since the last review update in 2013.
Selection criteria
We included peer‐reviewed published randomized controlled trials (RCTs) with at least five participants per study arm, comparing a psychological intervention with a control or comparison group. Trials involved children aged two to 19 years undergoing any needle‐related medical procedure.
Data collection and analysis
Two review authors extracted data and assessed risks of bias using the Cochrane 'Risk of bias' tool. We examined pain and distress assessed by child self‐report, observer global report, and behavioral measurement (primary outcomes). We also examined any reported physiological outcomes and adverse events (secondary outcomes). We used meta‐analysis to assess the efficacy of identified psychological interventions relative to a comparator (i.e. no treatment, other active treatment, treatment as usual, or waitlist) for each outcome separately. We used Review Manager 5 software to compute standardized mean differences (SMDs) with 95% confidence intervals (CIs), and GRADE to assess the quality of the evidence.
Main results
We included 59 trials (20 new for this update) with 5550 participants. Needle procedures primarily included venipuncture, intravenous insertion, and vaccine injections. Studies included children aged two to 19 years, with few trials focused on adolescents. The most common psychological interventions were distraction (n = 32), combined cognitive behavioral therapy (CBT; n = 18), and hypnosis (n = 8). Preparation/information (n = 4), breathing (n = 4), suggestion (n = 3), and memory alteration (n = 1) were also included. Control groups were often 'standard care', which varied across studies. Across all studies, 'Risk of bias' scores indicated several domains at high or unclear risk, most notably allocation concealment, blinding of participants and outcome assessment, and selective reporting. We downgraded the quality of evidence largely due to serious study limitations, inconsistency, and imprecision.
Very low‐ to low‐quality evidence supported the efficacy of distraction for self‐reported pain (n = 30, 2802 participants; SMD −0.56, 95% CI −0.78 to −0.33) and distress (n = 4, 426 participants; SMD −0.82, 95% CI −1.45 to −0.18), observer‐reported pain (n = 11, 1512 participants; SMD −0.62, 95% CI −1.00 to −0.23) and distress (n = 5, 1067 participants; SMD −0.72, 95% CI −1.41 to −0.03), and behavioral distress (n = 7, 500 participants; SMD −0.44, 95% CI −0.84 to −0.04). Distraction was not efficacious for behavioral pain (n = 4, 309 participants; SMD −0.33, 95% CI −0.69 to 0.03). Very low‐quality evidence indicated hypnosis was efficacious for reducing self‐reported pain (n = 5, 176 participants; SMD −1.40, 95% CI −2.32 to −0.48) and distress (n = 5, 176 participants; SMD −2.53, 95% CI −3.93 to −1.12), and behavioral distress (n = 6, 193 participants; SMD −1.15, 95% CI −1.76 to −0.53), but not behavioral pain (n = 2, 69 participants; SMD −0.38, 95% CI −1.57 to 0.81). No studies assessed hypnosis for observer‐reported pain and only one study assessed observer‐reported distress. Very low‐ to low‐quality evidence supported the efficacy of combined CBT for observer‐reported pain (n = 4, 385 participants; SMD −0.52, 95% CI −0.73 to −0.30) and behavioral distress (n = 11, 1105 participants; SMD −0.40, 95% CI −0.67 to −0.14), but not self‐reported pain (n = 14, 1359 participants; SMD −0.27, 95% CI −0.58 to 0.03), self‐reported distress (n = 6, 234 participants; SMD −0.26, 95% CI −0.56 to 0.04), observer‐reported distress (n = 6, 765 participants; SMD 0.08, 95% CI −0.34 to 0.50), or behavioral pain (n = 2, 95 participants; SMD −0.65, 95% CI −2.36 to 1.06). Very low‐quality evidence showed efficacy of breathing interventions for self‐reported pain (n = 4, 298 participants; SMD −1.04, 95% CI −1.86 to −0.22), but there were too few studies for meta‐analysis of other outcomes. Very low‐quality evidence revealed no effect for preparation/information (n = 4, 313 participants) or suggestion (n = 3, 218 participants) for any pain or distress outcome. Given only a single trial, we could draw no conclusions about memory alteration. Adverse events of respiratory difficulties were only reported in one breathing intervention.
Authors' conclusions
We identified evidence supporting the efficacy of distraction, hypnosis, combined CBT, and breathing interventions for reducing children’s needle‐related pain or distress, or both. Support for the efficacy of combined CBT and breathing interventions is new from our last review update due to the availability of new evidence. The quality of trials and overall evidence remains low to very low, underscoring the need for improved methodological rigor and trial reporting. Despite low‐quality evidence, the potential benefits of reduced pain or distress or both support the evidence in favor of using these interventions in clinical practice.
BACKGROUND:Most US studies of mortality and air pollution have been conducted on largely non-Hispanic white study populations. However, many health and mortality outcomes differ by race and ...ethnicity, and non-Hispanic white persons experience lower air pollution exposure than those who are non-Hispanic black or Hispanic. This study examines whether associations between air pollution and heart disease mortality differ by race/ethnicity.
METHODS:We used data from the 1997 to 2009 National Health Interview Survey linked to mortality records through December 2011 and annual estimates of fine particulate matter (PM2.5) by census tract. Proportional hazards models were used to estimate hazard ratios and 95% confidence intervals between PM2.5 (per 10 µg/m) and heart disease mortality using the full sample and the sample adults, which have information on additional health variables. Interaction terms were used to examine differences in the PM2.5-mortality association by race/ethnicity.
RESULTS:Overall, 65 936 of the full sample died during follow-up, and 22 152 died from heart disease. After adjustment for several factors, we found a significant positive association between PM2.5 and heart disease mortality (hazard ratio, 1.16; 95% confidence interval, 1.08–1.25). This association was similar in sample adults with adjustment for smoking and body mass index (hazard ratio, 1.18; 95% confidence interval, 1.06–1.31). Interaction terms for non-Hispanic black and Hispanic groups compared with the non-Hispanic white group were not statistically significant.
CONCLUSIONS:Using a nationally representative sample, the association between PM2.5 and heart disease mortality was elevated and similar to previous estimates. Associations for non-Hispanic black and Hispanic adults were not statistically significantly different from those for non-Hispanic white adults.
Neuropeptides released by hypothalamic neurons play a major role in the regulation of feeding, acting both within the hypothalamus, and at other appetite regulating centres throughout the brain. ...Where classical neurotransmitters signal only within synapses, neuropeptides diffuse over greater distances affecting both nearby and distant neurons expressing the relevant receptors, which are often extrasynaptic. As well as triggering a behavioural output, neuropeptides also act as neuromodulators: altering the response of neurons to both neurotransmitters and circulating signals of nutrient status. The mechanisms of action of hypothalamic neuropeptides with established roles in feeding, including melanin-concentrating hormone (MCH), the orexins, α-melanocyte stimulating hormone (α-MSH), agouti-gene related protein (AgRP), neuropeptide Y, and oxytocin, are reviewed in this article, with emphasis laid on both their effects on appetite regulating centres throughout the brain, and on examining the evidence for their physiological roles. In addition, evidence for the involvement of several putative appetite regulating hypothalamic neuropeptides is assessed including, ghrelin, cocaine and amphetamine-regulated transcript (CART), neuropeptide W and the galanin-like peptides.
This article is part of a Special Issue entitled ‘Central control of Food Intake’.
► Hypothalamic neuropeptides are thought to be involved in the regulation of appetite. ► Many neuropeptides form part of well established neuronal networks regulating appetite. ► Other neuropeptides affect appetite but do not yet have proven physiological roles in feeding. ► The downstream mechanisms of action of hypothalamic neuropeptides are beginning to be elucidated.
Summary Members of the genus Aeromonas inhabit various aquatic environments and are responsible for, and are implicated in, a number of intestinal and extra-intestinal infections in humans as well as ...other animals. This review focuses on invasive human infection and disease and summarizes available findings regarding the microbiology and detection of Aeromonas spp., with emphasis on successful identification and diagnosis, and the control of disease in the population. Antimicrobial resistance and therapy of Aeromonas spp. is also discussed.
It is established that the adipocyte-derived cytokine adiponectin protects against cardiovascular and metabolic diseases, but the effect of this adipokine on macrophage polarization, an important ...mediator of disease progression, has never been assessed. We hypothesized that adiponectin modulates macrophage polarization from that resembling a classically activated M1 phenotype to that resembling alternatively-activated M2 cells. Peritoneal macrophages and the stromal vascular fraction (SVF) cells of adipose tissue isolated from adiponectin knock-out mice displayed increased M1 markers, including tumor necrosis factor-α, interleukin-6, and monocyte chemoattractant protein-1 and decreased M2 markers, including arginase-1, macrophage galactose N-acetyl-galactosamine specific lectin-1, and interleukin-10. The systemic delivery of adenovirus expressing adiponectin significantly augmented arginase-1 expression in peritoneal macrophages and SVF cells in both wild-type and adiponectin knock-out mice. In culture, the treatment of macrophages with recombinant adiponectin protein led to an increase in the levels of M2 markers and a reduction of reactive oxygen species and reactive oxygen species-related gene expression. Adiponectin also stimulated the expression of M2 markers and attenuated the expression of M1 markers in human monocyte-derived macrophages and SVF cells isolated from human adipose tissue. These data show that adiponectin functions as a regulator of macrophage polarization, and they indicate that conditions of high adiponectin expression may deter metabolic and cardiovascular disease progression by favoring an anti-inflammatory phenotype in macrophages.
High-quality data are accurate, relevant, and timely. Large national health surveys have always balanced the implementation of these quality dimensions to meet the needs of diverse users. The ...COVID-19 pandemic shifted these balances, with both disrupted survey operations and a critical need for relevant and timely health data for decision-making. The National Health Interview Survey (NHIS) responded to these challenges with several operational changes to continue production in 2020. However, data files from the 2020 NHIS were not expected to be publicly available until fall 2021. To fill the gap, the National Center for Health Statistics (NCHS) turned to 2 online data collection platforms-the Census Bureau's Household Pulse Survey (HPS) and the NCHS Research and Development Survey (RANDS)-to collect COVID-19‒related data more quickly. This article describes the adaptations of NHIS and the use of HPS and RANDS during the pandemic in the context of the recently released Framework for Data Quality from the Federal Committee on Statistical Methodology. (
. 2021;111(12):2167-2175. https://doi.org/10.2105/AJPH.2021.306516).
Osteoarthritis (OA) causes pain and disability, with onset often during working age. Joint pain is associated with functional difficulties and may lead to work instability. The aims of this ...systematic review are to identify: the impact of OA on work participation; and biopsychosocial and work-related factors associated with absenteeism, presenteeism, work transitions, work impairment, work accommodations, and premature work loss.
Four databases were searched, including Medline. The Joanna Briggs Institute Critical Appraisal tools were used for quality assessment, with narrative synthesis to pool findings due to heterogeneity of study designs and work outcomes.
Nineteen studies met quality criteria (eight cohort; 11 cross-sectional): nine included OA of any joint(s), five knee-only, four knee and/or hip, and one knee, hip, and hand OA. All were conducted in high income countries. Absenteeism due to OA was low. Presenteeism rates were four times greater than absenteeism. Performing physically intensive work was associated with absenteeism, presenteeism, and premature work loss due to OA. Moderate-to-severe joint pain and pain interference were associated with presenteeism, work transition, and premature work loss. A smaller number of studies found that comorbidities were associated with absenteeism and work transitions. Two studies reported low co-worker support was associated with work transitions and premature work loss.
Physically intensive work, moderate-to-severe joint pain, co-morbidities, and low co-worker support potentially affects work participation in OA. Further research, using longitudinal study designs and examining the links between OA and biopsychosocial factors e.g., workplace accommodations, is needed to identify targets for interventions.
PROSPERO 2019 CRD42019133343 .
Relationships between chronic exposures to air pollution and respiratory health outcomes have yet to be clearly articulated for adults. Recent data from nationally representative surveys suggest ...increasing disparity by race/ethnicity regarding asthma-related morbidity and mortality. The objectives of this study are to evaluate the relationship between annual average ambient fine particulate matter (PM2.5) concentrations and respiratory outcomes for adults using modeled air pollution and health outcome data and to examine PM2.5 sensitivity across race/ethnicity.
Respondents from the 2002-2005 National Health Interview Survey (NHIS) were linked to annual kriged PM2.5 data from the USEPA AirData system. Logistic regression was employed to investigate increases in ambient PM2.5 concentrations and self-reported prevalence of respiratory outcomes including asthma, sinusitis and chronic bronchitis. Models included health, behavioral, demographic and resource-related covariates. Stratified analyses were conducted by race/ethnicity.
Of nearly 110,000 adult respondents, approximately 8,000 and 4,000 reported current asthma and recent attacks, respectively. Overall, odds ratios (OR) for current asthma (0.97 (95% Confidence Interval: 0.87-1.07)) and recent attacks (0.90 (0.78-1.03)) did not suggest an association with a 10 μg/m3 increase in PM2.5. Stratified analyses revealed significant associations for non-Hispanic blacks OR = 1.73 (1.17-2.56) for current asthma and OR = 1.76 (1.07-2.91) for recent attacks but not for Hispanics and non-Hispanic whites. Significant associations were observed overall (1.18 (1.08-1.30)) and in non-Hispanic whites (1.31 (1.18-1.46)) for sinusitis, but not for chronic bronchitis.
Non-Hispanic blacks may be at increased sensitivity of asthma outcomes from PM2.5 exposure. Increased chronic PM2.5 exposures in adults may contribute to population sinusitis burdens.
Small proteins perform a diverse array of functions, from microbial competition, to endocrine signaling, to building biomaterials. Microbial systems that can produce recombinant small proteins enable ...discovery of new effectors, exploration of sequence activity relationships, and have the potential for
delivery. However, we lack simple systems for controlling small-protein secretion from Gram-negative bacteria. Microcins are small-protein antibiotics secreted by Gram-negative bacteria that inhibit the growth of neighboring microbes. They are exported from the cytosol to the environment in a one-step process through a specific class of type I secretion systems (T1SSs). However, relatively little is known about substrate requirements for small proteins exported through microcin T1SSs. Here, we investigate the prototypic microcin V T1SS from Escherichia coli and show that it can export a remarkably wide range of natural and synthetic small proteins. We demonstrate that secretion is largely independent of the cargo protein's chemical properties and appears to be constrained only by protein length. We show that a varied range of bioactive sequences, including an antibacterial protein, a microbial signaling factor, a protease inhibitor, and a human hormone, can all be secreted and elicit their intended biological effect. Secretion through this system is not limited to E. coli, and we demonstrate its function in additional Gram-negative species that can inhabit the gastrointestinal tract. Our findings uncover the highly promiscuous nature of small-protein export through the microcin V T1SS, which has implications for native-cargo capacity and the use of this system in Gram-negative bacteria for small-protein research and delivery.
Type I secretion systems for microcin export in Gram-negative bacteria transport small antibacterial proteins from the cytoplasm to the extracellular environment in a single step. In nature, each secretion system is generally paired with a specific small protein. We know little about the export capacity of these transporters and how cargo sequence influences secretion. Here, we investigate the microcin V type I system. Remarkably, our studies show that this system can export small proteins of diverse sequence composition and is only limited by protein length. Furthermore, we demonstrate that a wide range of bioactive small proteins can be secreted and that this system can be used in Gram-negative species that colonize the gastrointestinal tract. These findings expand our understanding of secretion through type I systems and their potential uses in a variety of small-protein applications.
PDF
