Semaglutide Effects on Cardiovascular Outcomes in People With Overweight or Obesity (SELECT) rationale and design

Cardiovascular disease (CVD) is a major cause of morbidity and mortality. Although it has been widely appreciated that obesity is a major risk factor for CVD, treatments that produce effective, durable weight loss and the impact of weight reduction in reducing cardiovascular risk have been elusive. Instead, progress in CVD risk reduction has been achieved through medications indicated for controlling lipids, hyperglycemia, blood pressure, heart failure, inflammation, and/or thrombosis. Obesity has been implicated as promoting all these issues, suggesting that sustained, effective weight loss may have independent cardiovascular benefit. GLP-1 receptor agonists (RAs) reduce weight, improve glycemia, decrease cardiovascular events in those with diabetes, and may have additional cardioprotective effects. The GLP-1 RA semaglutide is in phase 3 studies as a medication for obesity treatment at a dose of 2.4 mg subcutaneously (s.c.) once weekly. Semaglutide Effects on Heart Disease and Stroke in Patients with Overweight or Obesity (SELECT) is a randomized, double-blind, parallel-group trial testing if semaglutide 2.4 mg subcutaneously once weekly is superior to placebo when added to standard of care for preventing major adverse cardiovascular events in patients with established CVD and overweight or obesity but without diabetes. SELECT is the first cardiovascular outcomes trial to evaluate superiority in major adverse cardiovascular events reduction for an antiobesity medication in such a population. As such, SELECT has the potential for advancing new approaches to CVD risk reduction while targeting obesity

Teams between Neo-Taylorism and Anti-Taylorism

The concept of teamworking is the product of two distinct developments. One: a neo- Tayloristic form of organization of work, of which Toyota has shown that it can be very profitable, was packaged and reframed to make it acceptable to the Western public. Two: anti-Tayloristic ways of organizing work, inspired by ideals of organizational democracy, were relabeled to make these acceptable to profit-oriented managers. Drawing on empirical research in Scandinavia, Germany, The Netherlands and the UK, as well as on published case studies of Japanese companies, the paper develops a neo-Tayloristic and an anti-Tayloristic model of teamworking. Key concerns in the teamworking literature are intensification of work and the use of shop floor autonomy as a cosmetic or manipulative device. Indeed, all the features of neo-Tayloristic teamworking are geared towards the intensification of work. However, one of the intensification mechanisms, the removal of Tayloristic rigidities in the division of labor, applies to anti-Tayloristic teamworking as well. This poses a dilemma for employee representatives. In terms of autonomy, on the other hand, the difference between neo-Tayloristic and anti-Tayloristic teamworking is real. In anti-Tayloristic teamworking, there is no supervisor inside the team. The function of spokesperson rotates. All team members can participate in decision-making. Standardization is not relentlessly pursued; management accepts some measure of worker control. There is a tendency to alleviate technical discipline, e.g. to find alternatives for the assembly line. Buffers are used. Remuneration is based on proven skill level; there are no group bonuses. In contrast, in neo-Tayloristic teamworking, a permanent supervisor is present in the team as team leader. At most, only the team leader can participate in decision-making. Standardization is relentlessly pursued. Management prerogatives are nearly unlimited. Job designers treat technical discipline, e.g. short-cycled work on the assembly line, as unproblematic. There are no buffers. A substantial part of wages consists of individual bonuses based on assessments by supervisors on how deeply workers cooperate in the system. Group bonuses are also given. The instability and vulnerability of anti-Tayloristic teamworking imply that it can only develop and flourish when managers and employee representatives put determined effort into it. The opportunity structure for this contains both economic and political elements. In mass production, the economic success of Toyota, through skillful mediation by management gurus, makes the opportunity structure for anti-Tayloristic teamworking relatively unfavorable

Patient education in rheumatoid arthritis: is the needs-based approach the way forward?

In recent years, the assessment of patients’ needs has become an important area of research for several reasons; expenditure on healthcare has risen faster than the cost increases reported in other sectors of the economy, and medical advances and demographic changes will continue the upward pressure on costs. At the same time, the resources available for healthcare are limited, and the rising expectations of the public have led to greater concerns about the quality of the services they receive

Association between food patterns and difficulties in falling asleep among adolescents in Norway - a descriptive Young-Hunt3 study

Aim Adolescents' sleep duration has decreased over the past century; this is mainly caused by problems with falling asleep. Short sleep duration, poor sleep quality, and later bedtimes, in addition to difficulties in falling asleep, are further associated with adolescents' increased food intake, poor diet quality, and excess body weight. Obesity has become a major health worldwide problem, with increasing prevalence among several age groups. In addition, higher body mass index is one of the most consistently reported correlates of short sleep duration. The aim of this study was to study if short sleep duration, connected with problems falling asleep, is associated with obesity and weight gain among Norwegian adolescents. Subject and methods This is a cross-sectional study using data from the Young-HUNT3 cohort study, which comprises the adolescent part of HUNT3. Young-HUNT3 includes data on 8217 participants aged 13 to 20 years old. Cluster analysis were used to categorize patterns of similarities in food consumption. Bivariate analyses were conducted to explore associations between difficulties in falling asleep and unhealthy food patterns. Results The analyses found statistically significant differences (< 0.001) between adolescents having an unhealthy food pattern, higher BMIs, and more difficulties with falling asleep than adolescents with a healthy food pattern. Conclusion This study shows that an unhealthy food pattern is associated with shorter sleep duration among Norwegian adolescents. Health promotion educational interventions focusing on disseminating knowledge to parents and adolescents about unhealthy food intake and other risk factors related to insufficient sleep ought to be developed

Early prognostic factors for disability in multiple sclerosis, a European multicenter study

The effects of initial clinical variables on short-term prognosis are analyzed in a cross-sectional study of 574 multiple sclerosis patients from 7 centers in 5 European countries. Patients with a primary progressive course had a 2.3 higher mean disability score (EDSS) than the primary remittent group after a mean duration of disease of 6.6 years. High age at onset was associated with a primary progressive course, and was also related to increased risk of a rapid shift to a secondary progressive course. Among the remittent patients without a secondary progressive course a high age at onset was significantly correlated to a higher disability score. In the whole remittent group the presence of pyramidal and cerebellar symptoms at onset predicted both a high disability score and a rapid shift to a secondary progression, while the effect was reverse for sensory and visual symptoms. No difference between the sexes was found