Myocardial infarction and mortality following joint surgery in patients with rheumatoid arthritis: a retrospective cohort study

Summary of patient level comparing those with rheumatoid arthritis to those without rheumatoid arthritis. (DOCX 14 kb

Investigating well-being, work limitations and preferences for self-management education and peer support among younger people with hip and knee osteoarthritis: protocol for a cross-sectional study

Introduction:&nbsp;Osteoarthritis (OA) has traditionally&nbsp;been considered a condition of older age. However,&nbsp;younger people are also affected by hip and knee OA,&nbsp;often as a result of sporting and work-related injuries.&nbsp;As OA studies have generally focused on older&nbsp;individuals, little is known about the experience of&nbsp;younger adults with hip or knee OA who can face a&nbsp;distinct set of pressures including work responsibilities&nbsp;and parenting roles. This study aims to investigate&nbsp;well-being and work participation among younger&nbsp;people with hip or knee OA, as well as preferences for&nbsp;OA education and support.Methods and analysis: 200 people aged 20&ndash;55 years with a diagnosis of hip and/or knee OA will be&nbsp;recruited for this cross-sectional study. Participants will&nbsp;be recruited from three major public hospitals in the&nbsp;state of Victoria, Australia following screening of&nbsp;orthopaedic outpatient clinic lists and referrals, and&nbsp;through community-based advertisements. A study&nbsp;questionnaire will be mailed to all participants and&nbsp;written informed consent obtained. Validated measures&nbsp;of Health-Related Quality of Life (HRQoL), health status,&nbsp;psychological distress and work limitations will be used. Information on health services use will be collected,&nbsp;in addition to information on the perceived utility and&nbsp;accessibility of a range of existing and proposed&nbsp;education and peer support models. HRQoL data will be&nbsp;compared with Australian population norms using&nbsp;independent t tests, and associations between HRQoL,&nbsp;health status, psychological distress, work limitations&nbsp;and demographic factors will be evaluated using&nbsp;univariate and multivariate analyses. Data on the&nbsp;perceived utility and accessibility of education and peer&nbsp;support models will be analysed descriptively.&nbsp;Ethics and dissemination: Ethics approval for the&nbsp;study has been obtained. The study findings will be&nbsp;submitted to peer-reviewed journals and arthritis&nbsp;consumer organisations for broader dissemination, and&nbsp;presented at national and international scientific meetings.</div

Managing complex medication regimens: perspectives of consumers with osteoarthritis and healthcare professionals

BACKGROUND: Managing medications is complex, particularly for consumers with multiple coexisting conditions for whom benefits and adverse effects are unpredictable and health priorities may be variable. OBJECTIVE: To investigate perceptions of and experiences with managing drug regimens from the perspectives of consumers with osteoarthritis and coexisting chronic conditions and of healthcare professionals from diverse backgrounds. METHODS: Using an exploratory research design, focus groups were formed with 34 consumers and 19 healthcare professionals. Individual interviews were undertaken with 3 community medical practitioners. RESULTS: Consumers\u27 management of medications was explored in terms of 3 themes: administration of medications, provision of information, and the perceived role of healthcare professionals. In general, consumers lacked understanding regarding the reason that they were prescribed certain medications. Since all consumer participants had at least 2 chronic conditions, they were taking many drugs to relieve undesirable symptoms. Some consumers were unable to achieve improved pain relief and were reluctant to take analgesics prescribed on an as - needed basis. Healthcare professionals discussed the importance of using non-pharmacologic measures to improve symptoms; however, consumers stated that physicians encourage them to continue using medications, often for prolonged periods, even when these agents are not helpful. CONCLUSIONS: Consumers were dissatisfied about the complexity of their medication regimens and also lacked understanding as to how to take their drugs effectively. Dedicated time should be devoted during medical consultations to facilitate verbal exchange of information about medications. Pharmacists must communicate regularly with physicians about consumers\u27 medication needs to help preempt any problems that may arise. Instructions need to be revised through collaboration between physicians and pharmacists so that &quot;as needed&quot; directions provide more explicit advice about when and how to use such drugs. Future research, using large, generalizable samples, should examine trends related to consumers\u27 experiences of symptomatic relief from chronic conditions and their understandings about medications. <br /

Adherence to Southern European Atlantic Diet and physical fitness on the atherogenic index of plasma in adolescents

We sought (i) to evaluate the associations of cardiorespiratory fitness (CRF), muscular fitness (MF) and Southern European Atlantic Diet (SEADiet) with atherogenic index of plasma (AIP) and (ii) to investigate de combined association of MF, CRF and SEADiet on AIP in adolescents. A cross-sectional school-based study was conducted on 493 adolescents (285 girls and 208 boys) aged 15-18 years, from the Portuguese Azorean Archipelago. CRF was measured by shuttle run test and MF by curl up and push up tests. Adherence to SEADiet was assessed with a semi-quantitative food frequency questionnaire (FFQ). The AIP was estimated as log (TG/HDL-C). Measures of pubertal stage and socioeconomic status were assessed. Linear regression showed a significant inverse association between MF (standardized β = -0.165; p \u3c 0.001), CRF (standardized β = -0.081; p \u3c 0.030) and SEADiet (standardized β = -0.081; p \u3c 0.045) with AIP, after adjustments for age, sex, pubertal stage and parental education. Furthermore, participants classified with an optimal as well as those with low adherence to a SEADiet but with LowMF/LowCRF had on average the highest AIP (F(7.482) = 3.270; p = 0.002). Moreover, optimal SEADiet with HighMF/HighCRF group showed the lowest AIP when compared with those with low adherence to a SEADiet with HighMF/HighCRF group (p = 0.03). AIP is inversely associated with MF, CRF and SEADiet. The low MF combined with a low CRF levels seems to overcome the potential healthy effect of having an optimal adherence to the SEADiet on AIP. However, an optimal adherence to SEADiet seems to improve the AIP in those adolescents with high fitness levels

Measurement of H₂O₂ within living drosophila during aging using a ratiometric mass spectrometry probe targeted to the mitochondrial matrix

Hydrogen peroxide (H&lt;sub&gt;2&lt;/sub&gt;O&lt;sub&gt;2&lt;/sub&gt;) is central to mitochondrial oxidative damage and redox signaling, but its roles are poorly understood due to the difficulty of measuring mitochondrial H&lt;sub&gt;2&lt;/sub&gt;O&lt;sub&gt;2&lt;/sub&gt; in vivo. Here we report a ratiometric mass spectrometry probe approach to assess mitochondrial matrix H&lt;sub&gt;2&lt;/sub&gt;O&lt;sub&gt;2&lt;/sub&gt; levels in vivo. The probe, MitoB, comprises a triphenylphosphonium (TPP) cation driving its accumulation within mitochondria, conjugated to an arylboronic acid that reacts with H&lt;sub&gt;2&lt;/sub&gt;O&lt;sub&gt;2&lt;/sub&gt; to form a phenol, MitoP. Quantifying the MitoP/MitoB ratio by liquid chromatography-tandem mass spectrometry enabled measurement of a weighted average of mitochondrial H&lt;sub&gt;2&lt;/sub&gt;O&lt;sub&gt;2&lt;/sub&gt; that predominantly reports on thoracic muscle mitochondria within living flies. There was an increase in mitochondrial H&lt;sub&gt;2&lt;/sub&gt;O&lt;sub&gt;2&lt;/sub&gt; with age in flies, which was not coordinately altered by interventions that modulated life span. Our findings provide approaches to investigate mitochondrial ROS in vivo and suggest that while an increase in overall mitochondrial H&lt;sub&gt;2&lt;/sub&gt;O&lt;sub&gt;2&lt;/sub&gt; correlates with aging, it may not be causative

The impact of socio-economic disadvantage on rates of hospital separations for diabetes-related foot disease in Victoria, Australia

<p>Abstract</p> <p>Background</p> <p>Information describing variation in health outcomes for individuals with diabetes related foot disease, across socioeconomic strata is lacking. The aim of this study was to investigate variation in rates of hospital separations for diabetes related foot disease and the relationship with levels of social advantage and disadvantage.</p> <p>Methods</p> <p>Using the Index of Relative Socioeconomic Disadvantage (IRSD) each local government area (LGA) across Victoria was ranked from most to least disadvantaged. Those LGAs ranked at the lowest end of the scale and therefore at greater disadvantage (Group D) were compared with those at the highest end of the scale (Group A), in terms of total and per capita hospital separations for peripheral neuropathy, peripheral vascular disease, foot ulceration, cellulitis and osteomyelitis and amputation. Hospital separations data were compiled from the Victorian Admitted Episodes Database.</p> <p>Results</p> <p>Total and per capita separations were 2,268 (75.3/1,000 with diabetes) and 2,734 (62.3/1,000 with diabetes) for Group D and Group A respectively. Most notable variation was for foot ulceration (Group D, 18.1/1,000 <it>versus </it>Group A, 12.7/1,000, rate ratio 1.4, 95% CI 1.3, 1.6) and below knee amputation (Group D 7.4/1,000 <it>versus </it>Group A 4.1/1,000, rate ratio 1.8, 95% CI 1.5, 2.2). Males recorded a greater overall number of hospital separations across both socioeconomic strata with 66.2% of all separations for Group D and 81.0% of all separations for Group A recorded by males. However, when comparing mean age, males from Group D tended to be younger compared with males from Group A (mean age; 53.0 years <it>versus </it>68.7 years).</p> <p>Conclusion</p> <p>Variation appears to exist for hospital separations for diabetes related foot disease across socioeconomic strata. Specific strategies should be incorporated into health policy and planning to combat disparities between health outcomes and social status.</p

A universal influenza mRNA vaccine candidate boosts T cell responses and reduces zoonotic influenza virus disease in ferrets

Universal influenza vaccines should protect against continuously evolving and newly emerging influenza viruses. T cells may be an essential target of such vaccines, as they can clear infected cells through recognition of conserved influenza virus epitopes. We evaluated a novel T cell-inducing nucleoside-modified messenger RNA (mRNA) vaccine that encodes the conserved nucleoprotein, matrix protein 1, and polymerase basic protein 1 of an H1N1 influenza virus. To mimic the human situation, we applied the mRNA vaccine as a prime-boost regimen in naïve ferrets (mimicking young children) and as a booster in influenza-experienced ferrets (mimicking adults). The vaccine induced and boosted broadly reactive T cells in the circulation, bone marrow, and respiratory tract. Booster vaccination enhanced protection against heterosubtypic infection with a potential pandemic H7N9 influenza virus in influenza-experienced ferrets. Our findings show that mRNA vaccines encoding internal influenza virus proteins represent a promising strategy to induce broadly protective T cell immunity against influenza viruses.</p

Acceptability of the 6-PACK falls prevention program: A pre-implementation study in hospitals participating in a cluster randomized controlled trial

There is limited evidence to support the effectiveness of falls prevention interventions in the acute hospital setting. The 6-PACK falls prevention program includes a fall-risk tool; 'falls alert' signs; supervision of patients in the bathroom; ensuring patients' walking AIDS are within reach; toileting regimes; low-low beds; and bed/chair alarms. This study explored the acceptability of the 6-PACK program from the perspective of nurses and senior staff prior to its implementation in a randomised controlled trial. A mixed-methods approach was applied involving 24 acute wards from six Australian hospitals. Participants were nurses working on participating wards and senior hospital staff including: Nurse Unit Managers; senior physicians; Directors of Nursing; and senior personnel involved in quality and safety or falls prevention. Information on program acceptability (suitability, practicality and benefits) was obtained by surveys, focus groups and interviews. Survey data were analysed descriptively, and focus group and interview data thematically. The survey response rate was 60%. Twelve focus groups (n = 96 nurses) and 24 interviews with senior staff were conducted. Falls were identified as a priority patient safety issue and nurses as key players in falls prevention. The 6-PACK program was perceived to offer practical benefits compared to current practice. Nurses agreed fall-risk tools, low-low beds and alert signs were useful for preventing falls (&gt;70%). Views were mixed regarding positioning patients' walking aid within reach. Practical issues raised included access to equipment; and risk of staff injury with low-low bed use. Bathroom supervision was seen to be beneficial, however not always practical. Views on the program appropriateness and benefits were consistent across nurses and senior staff. Staff perceived the 6-PACK program as suitable, practical and beneficial, and were open to adopting the program. Some practical concerns were raised highlighting issues to be addressed by the implementation plan

Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

Background: Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings. A barrier to using quality indicators is lack of access to routinely collected clinical data. The interRAI Acute Care (AC) assessment system supports comprehensive geriatric assessment of older people within routine daily practice in hospital and includes process and outcome data pertaining to geriatric syndromes. This paper reports the study protocol for the development of aged care quality indicators for acute care hospitals. Methods/Design. The study will be conducted in three phases:. 1. Development of a preliminary inclusive set of quality indicators set based on a literature review and expert panel consultation,. 2. A prospective field study including recruitment of 480 patients aged 70 years or older across 9 Australian hospitals. Each patient will be assessed on admission and discharge using the interRAI AC, and will undergo daily monitoring to observe outcomes. Medical records will be independently audited, and. 3. Analysis and compilation of a definitive quality indicator set, including two anonymous voting rounds for quality indicator inclusion by the expert panel. Discussion. The approach to quality indicators proposed in this protocol has four distinct advantages over previous efforts: the quality indicators focus on outcomes; they can be collected as part of a routinely applied clinical information and decision support system; the clinical data will be robust and will contribute to better understanding variations in hospital care of older patients; The quality indicators will have international relevance as they will be built on the interRAI assessment instrument, an internationally recognised clinical system