Inflammatory bowel disease nurse specialists for patients on biological therapies: a nationwide Italian survey

Background Management of inflammatory bowel disease (IBD) patients requires a multidisciplinary approach. Among the working team, the role of IBD nurse is expected to be particularly relevant when managing patients receiving biological therapies. We performed a survey to assess the presence of IBD nurse in centers where patients were receiving biologics. Methods For this Italian nationwide survey a specific questionnaire was prepared. IBD nurse was defined as a nurse directly involved in all phases of biological therapy, from pre-therapy screening, administration and monitoring during therapy, to follow up performed by a dedicated helpline, completed a specific training on biological therapy therapy, and observed international guidelines. Results A total of 53 Italian IBD centers participated in the survey, and 91 valid questionnaires were collected. Overall, 34 (37.4%) nurses could be classified as IBD specialists. IBD nurses had a significantly higher educational level than other nurses, they were more frequently operating in Central or Southern than in Northern Italy, they were working in an Academic center rather than in a General hospital, and in IBD centers with >25 patients on biological therapy. On the contrary, mean age, gender distribution, years of nursing, and years working in the IBD unit did not significantly differ between IBD and other nurses. Conclusions Our nationwide survey showed that the presence of an IBD nurse is still lacking in the majority of Italian IBD centers where patients receive biological therapies, suggesting a prompt implementation

Evolution, Ecology, and Disparities: Constructing Stature, Immune Functioning, and Reproduction in Brazilian Quilombo, and United States, Women

The purpose of this dissertation is to test how growth, reproduction, and immune functioning interact in two populations of adult women residing in vastly different socio-economic and ecological environments, the Kalunga quilombo in Brazil, and the United States of America. The presence of life history trade-offs was tested to determine how the different envirnonments, and socio-ecological contexts of the populations were creating differential risks for health and reproductive outcomes, and life history trade-offs. I hypothesized that the Kalunga people, living in very difficult and harsh conditions, would experience greater amounts of, and more severe, life history trade-offs than the U.S. women. I also hypothesized that in both populations, syndemic interactions between health outcomes, and the larger macro-social conditions, would influence stature, immune functioning, and reproduction. Additionally, these syndemic interactions would perpetuate poor health and reproductive outcomes within the entire Kalunga population, and portions of the U.S. population. I collaborated with the University of Brasilia to collect data adult women from in the Kalunga quilombo in Goiás State, Brazil (n=38) via semi-structured interviews in 2016. In addition, these data were compiled with reproductive, demographic, anthropometric, biological, and socio-economic data collected from adult Kalunga women in 2015 by the University of Brasilia’s Department of Genetics and Morphology. Demographic, anthropometric, biological, and socio-economic data recorded in the National Health and Nutrition Examination Survey (NHANES) 2005-2006 from adult U.S. women was also analyzed. Life history traits were measured through stature (cm), Immunoglobulin E (IgE; kU/l), and reproductive variables (fertility, and reproductive ages) for both populations. My results demonstrated that life history trade-offs impact diverse populations. I found evidence to support life history trade-offs occurred between stature and fertility, and stature and reproductive ages, in both populations. However, my results also indicated that the socio-economic, and ecological, conditions of both populations heavily influenced stature and reproduction in the women. Life history trade-offs were not observable between immune functioning and fertility in the Kalunga population, and not readily evident in the U.S. sample. The positive associations between IgE and fertility in the U.S. women indicate that while life history trade-offs may be suggested, other biocultural variables including: low income, ethnicity, education, and body size, are stronger influences on immune functioning, and fertility, in the U.S. women. Though the Kalunga women had a history of infectious and parasitic diseases, and lived in conditions of poor sanitation and poverty, they had multiple ways of mitigating the stresses of their everyday life. The shared socio-ecological conditions of their community decreased the deprivations they experienced, reduced the disabilities they felt from their health statuses, and was reflected in relative homogeneity of their lived experience. In contrast, the U.S. population was dictated by disparities. Poor health and reproductive outcomes were concentrated disproportionately in low-income, less educated, and/or minority ethnicity status, women. The findings of this dissertation have important implications for applied anthropology and the study of life history theory. My results demonstrate that Western lifestyles must be considered as instigators of life history trade-offs, and life history scholarship in humans must also focus on populations living in these conditions. Additionally, the secular changes resulting in lowered ages of menarche in U.S. women could lead to future poor health outcomes. As the Kalunga transitions into a more Western lifestyle, they are at risk for disparities within their population. It is imperative for applied anthropologists to be engaged in addressing the immune, nutritional, and psychosocial stressors within populations that perpetuate disparities, and instigate and/or exacerbate life history trade-offs

Evolution, Ecology, and Disparities: Constructing Stature, Immune Functioning, and Reproduction in Brazilian Quilombo, and United States, Women

The purpose of this dissertation is to test how growth, reproduction, and immune functioning interact in two populations of adult women residing in vastly different socio-economic and ecological environments, the Kalunga quilombo in Brazil, and the United States of America. The presence of life history trade-offs was tested to determine how the different envirnonments, and socio-ecological contexts of the populations were creating differential risks for health and reproductive outcomes, and life history trade-offs. I hypothesized that the Kalunga people, living in very difficult and harsh conditions, would experience greater amounts of, and more severe, life history trade-offs than the U.S. women. I also hypothesized that in both populations, syndemic interactions between health outcomes, and the larger macro-social conditions, would influence stature, immune functioning, and reproduction. Additionally, these syndemic interactions would perpetuate poor health and reproductive outcomes within the entire Kalunga population, and portions of the U.S. population. I collaborated with the University of Brasilia to collect data adult women from in the Kalunga quilombo in Goiás State, Brazil (n=38) via semi-structured interviews in 2016. In addition, these data were compiled with reproductive, demographic, anthropometric, biological, and socio-economic data collected from adult Kalunga women in 2015 by the University of Brasilia’s Department of Genetics and Morphology. Demographic, anthropometric, biological, and socio-economic data recorded in the National Health and Nutrition Examination Survey (NHANES) 2005-2006 from adult U.S. women was also analyzed. Life history traits were measured through stature (cm), Immunoglobulin E (IgE; kU/l), and reproductive variables (fertility, and reproductive ages) for both populations. My results demonstrated that life history trade-offs impact diverse populations. I found evidence to support life history trade-offs occurred between stature and fertility, and stature and reproductive ages, in both populations. However, my results also indicated that the socio-economic, and ecological, conditions of both populations heavily influenced stature and reproduction in the women. Life history trade-offs were not observable between immune functioning and fertility in the Kalunga population, and not readily evident in the U.S. sample. The positive associations between IgE and fertility in the U.S. women indicate that while life history trade-offs may be suggested, other biocultural variables including: low income, ethnicity, education, and body size, are stronger influences on immune functioning, and fertility, in the U.S. women. Though the Kalunga women had a history of infectious and parasitic diseases, and lived in conditions of poor sanitation and poverty, they had multiple ways of mitigating the stresses of their everyday life. The shared socio-ecological conditions of their community decreased the deprivations they experienced, reduced the disabilities they felt from their health statuses, and was reflected in relative homogeneity of their lived experience. In contrast, the U.S. population was dictated by disparities. Poor health and reproductive outcomes were concentrated disproportionately in low-income, less educated, and/or minority ethnicity status, women. The findings of this dissertation have important implications for applied anthropology and the study of life history theory. My results demonstrate that Western lifestyles must be considered as instigators of life history trade-offs, and life history scholarship in humans must also focus on populations living in these conditions. Additionally, the secular changes resulting in lowered ages of menarche in U.S. women could lead to future poor health outcomes. As the Kalunga transitions into a more Western lifestyle, they are at risk for disparities within their population. It is imperative for applied anthropologists to be engaged in addressing the immune, nutritional, and psychosocial stressors within populations that perpetuate disparities, and instigate and/or exacerbate life history trade-offs

Early Maturity, Shortened Stature, and Hardship: Can Life-history Trade-offs Indicate Social Stratification and Income Inequality in the United States?

Objective: Life-history strategies promote reproductive fitness and survival. Limited energy availability and competing energetic demands between life-history decisions may result in organismal trade-offs leading to selection for “optimal” traits that facilitate fitness and survival in present environmental conditions. Few life-history analyses have been conducted in food abundant/high resource human populations. Here, we use a life-history theory framework integrated with a biocultural approach to assess whether trade-offs between growth (height) and the onset of reproductive maturation (ages at menarche) were observed in a sample of adult women living in the United States Methods: Adult women (18 years and older) from the National Health and Nutrition Examination Survey (NHANES) 2005 to 2006 were analyzed using complex survey regression to evaluate associations between ages at menarche, height, and biological, socio-economic, demographic, and anthropometric variables. Associations between stature, ages at menarche, and socio-economic status (household income and education level) suggest life-history trade-offs in this populations may be mitigated by access to resources and marginalization. Conlusions: These study results have applied public health implications. We demonstrate that females who experience early menarche in the US population achieve short stature. Our study also demonstrates the need for implementing life-history analyses in Western affluent populations, where marginalization may result in life-history trade-offs

Assessing the impact of high blood pressure referrals on hypertension awareness and management, BMI, and blood pressure values in adult Samoans 2010–2019

The Samoan population has experienced rapid increases in the prevalence of non-communicable diseases (NCDs) and NCD risk factors over the last 30 years. However, understanding how increased awareness and treatment of these conditions in reducing disease burden remains understudied. Using data from a longitudinal study (2010–2019) of cardiometabolic health among Samoan adults, we assess the impact of a referral for elevated blood pressure (BP) on changes in BP, physician’s diagnoses of hypertension and medication use, body mass index (BMI), and other risk factors for elevated BP. Analyses compared adult Samoans (n = 328) who in 2010 either (1) received a referral for elevated BP (BP ≥ 140/90 mmHg) or (2) had measured BP indicative of pre-hypertension (BP ≥ 120/80 mmHg) but were not referred. Data were analysed using linear and logistic regression, paired T- and McNemar’s tests, and Wilcoxon Rank Sum assessments. Referrals in 2010 significantly increased the odds of reporting a physician’s diagnosis of hypertension (OR 2.16; 1.18, 3.95) and hypertension medication use (OR 3.52; 1.86, 6.73) in 2018; however, referrals, medication use, and diagnoses were not associated with BP values or reduced odds of having elevated BP. Despite the referral having positive effects on hypertension-related health care, our results demonstrate that other factors are influencing effective BP/hypertension control. We advocate for greater engagement of health researchers with local health sector actors to improve the probability that researcher-provided health referrals will result in long-term health improvements

Identifying patient preferences for diabetes care: A protocol for implementing a discrete choice experiment in Samoa.

In Samoa, adult Type 2 diabetes prevalence has increased within the past 30 years. Patient preferences for care are factors known to influence treatment adherence and are associated with reduced disease progression and severity. However, patient preferences for diabetes care, generally, are understudied, and other patient-centered factors such as willingness-to-pay (WTP) for diabetes treatment have never been explored in this setting. Discrete Choice Experiments (DCE) are useful tools to elicit preferences and WTP for healthcare. DCEs present patients with hypothetical scenarios composed of a series of multi-alternative choice profiles made up of attributes and levels. Patients choose a profile based on which attributes and levels may be preferable for them, thereby quantifying and identifying locally relevant patient-centered preferences. This paper presents the protocol for the design, piloting, and implementation of a DCE identifying patient preferences for diabetes care, in Samoa. Using an exploratory sequential mixed methods design, formative data from a literature review and semi-structured interviews with n = 20 Samoan adults living with Type 2 diabetes was used to design a Best-Best DCE instrument. Experimental design procedures were used to reduce the number of choice-sets and balance the instrument. Following pilot testing, the DCE is being administered to n = 450 Samoan adults living with diabetes, along with associated questionnaires, and anthropometrics. Subsequently, we will also be assessing longitudinally how preferences for care change over time. Data will be analyzed using progressive mixed Rank Order Logit models. The results will identify which diabetes care attributes are important to patients (p < 0.05), examine associations between participant characteristics and preference, illuminate the trade-offs participants are willing to make, and the probability of uptake, and WTP for specific attributes and levels. The results from this study will provide integral data useful for designing and adapting efficacious diabetes intervention and treatment approaches in this setting

Protocol: Implementation and evaluation of an adolescent-mediated intervention to improve glycemic control and diabetes self-management among Samoan adults.

BackgroundDiagnoses of Type 2 Diabetes in the United States have more than doubled in the last two decades. One minority group at disproportionate risk are Pacific Islanders who face numerous barriers to prevention and self-care. To address the need for prevention and treatment in this group, and building on the family-centered culture, we will pilot test an adolescent-mediated intervention designed to improve the glycemic control and self-care practices of a paired adult family member with diagnosed diabetes.MethodsWe will conduct a randomized controlled trial in American Samoa among n = 160 dyads (adolescent without diabetes, adult with diabetes). Adolescents will receive either a six-month diabetes intervention or a leadership and life skills-focused control curriculum. Aside from research assessments we will have no contact with the adults in the dyad who will proceed with their usual care. To test our hypothesis that adolescents will be effective conduits of diabetes knowledge and will support their paired adult in the adoption of self-care strategies, our primary efficacy outcomes will be adult glycemic control and cardiovascular risk factors (BMI, blood pressure, waist circumference). Secondarily, since we believe exposure to the intervention may encourage positive behavior change in the adolescent themselves, we will measure the same outcomes in adolescents. Outcomes will be measured at baseline, after active intervention (six months post-randomization) and at 12-months post-randomization to examine maintenance effects. To determine potential for sustainability and scale up, we will examine intervention acceptability, feasibility, fidelity, reach, and cost.DiscussionThis study will explore Samoan adolescents' ability to act as agents of familial health behavior change. Intervention success would produce a scalable program with potential for replication in other family-centered ethnic minority groups across the US who are the ideal beneficiaries of innovations to reduce chronic disease risk and eliminate health disparities

Exploring the paradoxical relationship of a Creb 3 Regulatory Factor missense variant with body mass index and diabetes among Samoans: Protocol for the Soifua Manuia (Good Health) observational cohort study

Background:The prevalence of obesity and diabetes in Samoa, like many other Pacific Island nations, has reached epidemic proportions. Although the etiology of these conditions can be largely attributed to the rapidly changing economic and nutritional environment, a recently identified genetic variant, rs373863828 (CREB 3 regulatory factor, CREBRF: c.1370G&gt;A p.[R457Q]) is associated with increased odds of obesity, but paradoxically, decreased odds of diabetes.Objective:The overarching goal of the Soifua Manuia (Good Health) study was to precisely characterize the association of the CREBRF variant with metabolic (body composition and glucose homeostasis) and behavioral traits (dietary intake, physical activity, sleep, and weight control behaviors) that influence energy homeostasis in 500 adults.Methods:A cohort of adult Samoans who participated in a genome-wide association study of adiposity in Samoa in 2010 was followed up, based on the presence or absence of the CREBRF variant, between August 2017 and March 2019. Over a period of 7-10 days, each participant completed the main study protocol, which consisted of anthropometric measurements (weight, height, circumferences, and skinfolds), body composition assessment (bioelectrical impedance and dual-energy x-ray absorptiometry), point-of-care glycated hemoglobin measurement, a fasting blood draw and oral glucose tolerance test, urine collection, blood pressure measurement, hand grip strength measurement, objective physical activity and sleep apnea monitoring, and questionnaire measures (eg, health interview, cigarette and alcohol use, food frequency questionnaire, socioeconomic position, stress, social support, food and water insecurity, sleep, body image, and dietary preferences). In January 2019, a subsample of the study participants (n=118) completed a buttock fat biopsy procedure to collect subcutaneous adipose tissue samples.Results:Enrollment of 519 participants was completed in March 2019. Data analyses are ongoing, with results expected in 2020 and 2021.Conclusions:While the genetic variant rs373863828, in CREBRF, has the largest known effect size of any identified common obesity gene, very little is currently understood about the mechanisms by which it confers increased odds of obesity but paradoxically lowered odds of type 2 diabetes. The results of this study will provide insights into how the gene functions on a whole-body level, which could provide novel targets to prevent or treat obesity, diabetes, and associated metabolic disorders. This study represents the human arm of a comprehensive and integrated approach involving humans as well as preclinical models that will provide novel insights into metabolic disease

Subtype-selective small molecule inhibitors reveal a fundamental role for Nav1.7 in nociceptor electrogenesis, axonal conduction and presynaptic release

Human genetic studies show that the voltage gated sodium channel 1.7 (Nav1.7) is a key molecular determinant of pain sensation. However, defining the Nav1.7 contribution to nociceptive signalling has been hampered by a lack of selective inhibitors. Here we report two potent and selective arylsulfonamide Nav1.7 inhibitors; PF-05198007 and PF-05089771, which we have used to directly interrogate Nav1.7's role in nociceptor physiology. We report that Nav1.7 is the predominant functional TTX-sensitive Nav in mouse and human nociceptors and contributes to the initiation and the upstroke phase of the nociceptor action potential. Moreover, we confirm a role for Nav1.7 in influencing synaptic transmission in the dorsal horn of the spinal cord as well as peripheral neuropeptide release in the skin. These findings demonstrate multiple contributions of Nav1.7 to nociceptor signalling and shed new light on the relative functional contribution of this channel to peripheral and central noxious signal transmission

Subtype-Selective Small Molecule Inhibitors Reveal a Fundamental Role for Nav1.7 in Nociceptor Electrogenesis, Axonal Conduction and Presynaptic Release

<div><p>Human genetic studies show that the voltage gated sodium channel 1.7 (Na_v1.7) is a key molecular determinant of pain sensation. However, defining the Na_v1.7 contribution to nociceptive signalling has been hampered by a lack of selective inhibitors. Here we report two potent and selective arylsulfonamide Na_v1.7 inhibitors; PF-05198007 and PF-05089771, which we have used to directly interrogate Na_v1.7’s role in nociceptor physiology. We report that Na_v1.7 is the predominant functional TTX-sensitive Na_v in mouse and human nociceptors and contributes to the initiation and the upstroke phase of the nociceptor action potential. Moreover, we confirm a role for Na_v1.7 in influencing synaptic transmission in the dorsal horn of the spinal cord as well as peripheral neuropeptide release in the skin. These findings demonstrate multiple contributions of Na_v1.7 to nociceptor signalling and shed new light on the relative functional contribution of this channel to peripheral and central noxious signal transmission.</p></div