Population-based epidemiological projections of rheumatoid arthritis in Germany until 2040

Our aim was to conduct a population-based projection to estimate the number of rheumatoid arthritis (RA) cases in Germany until 2040. Data obtained from a report published in 2017 (doi:10.20364/VA-17.08) were used for future prediction analysis. The data were originally collected by the German Central Institute for Statutory Health Insurance. We used the illness–death model to estimate future numbers of RA cases, considering nine possible scenarios based on different incidence and mortality rates. In the baseline scenario, the number of women with RA is projected to increase by 417 000 cases and men by 179 000 cases by 2040, compared with 2015. Peak numbers of cases are concentrated in the 70–80-year-old age group, particularly among women. In the most favourable scenario (scenario 2), assuming a decreasing incidence, the total number of RA cases is projected to rise by 284 000 by 2040, reflecting a 38% relative increase from 2015 to 2040. The least favourable scenario (scenario 9), assuming an increasing incidence, projects a significant burden on the healthcare system. The total number of RA cases is expected to rise by 1.16 million by 2040, marking a substantial 158% relative increase from 2015 to 2040. Our research emphasizes a discernible trend: with an ageing society, improving treatment effectiveness, and declining all-cause mortality, we anticipate a rise in the absolute numbers of RA cases in Germany in the coming years. Our models robustly support this viewpoint, underscoring impending challenges for healthcare systems. Addressing these challenges demands multifaceted interventions.</p

A Qualitative Study of the Benefits and Challenges of Fitness Testing and Activity Monitoring in School; Interviews with School Staff in Southern California

A Qualitative Study of the Benefits and Challenges of Fitness Testing and Activity Monitoring in School; Interviews with School Staff in Southern Californi

Pelvic ultrasounds referred from the emergency department: Agreement between sonographer findings and radiologists' reports

AbstractIntroductionWhen radiologists are not available, sonographers may be able to provide an interim report, especially for patients referred from emergency or in remote clinics. The aim of this study was to compare the agreement of diagnostic findings between sonographers and radiologists for patients referred from the emergency department for pelvic ultrasound.MethodsSonographer findings and corresponding radiologists' reports of consecutive pelvic ultrasound examinations referred from the emergency department were compared prospectively over a 7‐month period. Paediatric cases were excluded. Diagnostic agreement was scored by an independent investigator into the following: grade 1—agree with radiologist report; grade 2—minor discrepancy, unlikely to impact patient management; grade 3—major discrepancy, likely to impact patient management but does not lead to adverse outcomes for the patient; and grade 4—major discrepancy, findings likely to result in significantly adverse outcome for the patient.ResultsA total of 118 cases were recruited. Of those, 113 (95.7%) were graded as grade 1, four (3.4%) were graded as grade 2 and one as grade 3 (0.8%). No cases were categorised as grade 4. The case classified as grade 3 was initially reported by the sonographer as early ovarian torsion. The corresponding radiologist's report documented no evidence of ovarian torsion. However, three days later, the woman underwent emergency surgery where ovarian torsion was confirmed and the ovary removed.ConclusionWhen radiologists are unavailable to report on urgent cases requiring pelvic ultrasound, sonographers can provide accurate interim reports to assist in the timely management of patients

Fiji : assessment of the social protection system in Fiji and recommendations for policy changes

An assessment of the social protection system in Fiji and recommendations for policy change

Specific Gait Changes in Prodromal Hereditary Spastic Paraplegia Type 4: preSPG4 Study

Background: In hereditary spastic paraplegia type 4 (SPG4), subclinical gait changes might occur years before patients realize gait disturbances. The prodromal phase of neurodegenerative disease is of particular interest to halt disease progression by future interventions before impairment has manifested. Objective: The objective of this study was to identify specific movement abnormalities before the manifestation of gait impairment and quantify disease progression in the prodromal phase.  Methods: Seventy subjects participated in gait assessment, including 30 prodromal SPAST pathogenic variant carriers, 17 patients with mild-to-moderate manifest SPG4, and 23 healthy control subjects. An infrared-camera-based motion capture system assessed gait to analyze features such as range of motion and continuous angle trajectories. Those features were correlated with disease severity as assessed by the Spastic Paraplegia Rating Scale, neurofilament light chain as a fluid biomarker indicating neurodegeneration, and motor-evoked potentials.  Results: Compared with healthy control subjects, we found an altered gait pattern in prodromal pathogenic variant carriers during the swing phase in the segmental angle of the foot (Dunn's post hoc test, q = 3.1) and heel ground clearance (q = 2.8). Furthermore, range of motion of segmental angle was reduced for the foot (q = 3.3). These changes occurred in prodromal pathogenic variant carriers without quantified leg spasticity in clinical examination. Gait features correlated with neurofilament light chain levels, central motor conduction times of motor-evoked potentials, and Spastic Paraplegia Rating Scale score.  Conclusions: Gait analysis can quantify changes in prodromal and mild-to-moderate manifest SPG4 patients. Thus, gait features constitute promising motor biomarkers characterizing the subclinical progression of spastic gait and might help to evaluate interventions in early disease stages. </p

Can digital technologies increase consumer acceptance of circular business models? The case of second hand fashion

Experimentation with, and the implementation of, circular business models (CBMs) has gained rapid traction within the textiles and fashion industry over the last five years. Substitution of virgin materials with bioderived alternatives, extending the lifecycle of garments through resale, and rental services and the recycling or upcycling of garments are some of the strategies being used to reduce the 1.2 billion tonnes of greenhouse gas emissions and 92 million tonnes of waste associated with the sector in 2017. However, whilst CBMs demonstrate environmental and economic benefits, low consumer acceptance is considered by business professionals and policymakers to be one of the main barriers to the transition towards a circular economy. Digitisation is widely acknowledged as a catalyst for innovation in many sectors and digital technologies are driving new ways to exchange and share goods and services, enabling companies to match the supply, and demand for, otherwise underused assets and products. Online platforms, in particular, have played a crucial role in driving the growth of used goods and resale in other consumer goods markets, such as consumer technology. A mixed methods approach, including a review of 40 organisations operating second hand fashion models, a consumer survey of over 1200 respondents and in-depth interviews with 10 organisations operating second hand fashion models, is adopted to reveal (a) the barriers to consumer acceptance of reuse models in the fashion industry, and (b) how digital technologies can overcome these barriers. Findings highlight the significant progress that organisations have made in using digitalisation, including data analytics, algorithms, digital platforms, advanced product imagery and data informed customer communications, to address barriers associated with convenience, hygiene, trust and security. Furthermore, the study identifies opportunities for the development of more sophisticated digital technologies to support increased transparency and address concerns associated with the quality, authenticity and sourcing of materials. Positioned at the interface of digitisation and consumer acceptance of circular business models, this study makes an important contribution to understanding consumer barriers and how to address them and concludes with a set of recommendations for practitioners

Specific Gait Changes in Prodromal Hereditary Spastic Paraplegia Type 4: preSPG4 Study

Background: In hereditary spastic paraplegia type 4 (SPG4), subclinical gait changes might occur years before patients realize gait disturbances. The prodromal phase of neurodegenerative disease is of particular interest to halt disease progression by future interventions before impairment has manifested. Objective: The objective of this study was to identify specific movement abnormalities before the manifestation of gait impairment and quantify disease progression in the prodromal phase.  Methods: Seventy subjects participated in gait assessment, including 30 prodromal SPAST pathogenic variant carriers, 17 patients with mild-to-moderate manifest SPG4, and 23 healthy control subjects. An infrared-camera-based motion capture system assessed gait to analyze features such as range of motion and continuous angle trajectories. Those features were correlated with disease severity as assessed by the Spastic Paraplegia Rating Scale, neurofilament light chain as a fluid biomarker indicating neurodegeneration, and motor-evoked potentials.  Results: Compared with healthy control subjects, we found an altered gait pattern in prodromal pathogenic variant carriers during the swing phase in the segmental angle of the foot (Dunn's post hoc test, q = 3.1) and heel ground clearance (q = 2.8). Furthermore, range of motion of segmental angle was reduced for the foot (q = 3.3). These changes occurred in prodromal pathogenic variant carriers without quantified leg spasticity in clinical examination. Gait features correlated with neurofilament light chain levels, central motor conduction times of motor-evoked potentials, and Spastic Paraplegia Rating Scale score.  Conclusions: Gait analysis can quantify changes in prodromal and mild-to-moderate manifest SPG4 patients. Thus, gait features constitute promising motor biomarkers characterizing the subclinical progression of spastic gait and might help to evaluate interventions in early disease stages. </p

Supplemental material for Successful conception in a 34-year-old lupus patient following spontaneous pregnancy after autotransplantation of cryopreserved ovarian tissue

Supplemental Material for Successful conception in a 34-year-old lupus patient following spontaneous pregnancy after autotransplantation of cryopreserved ovarian tissue by G Chehab, J Krüssel, T Fehm, R Fischer-Betz, M Schneider, A Germeyer, MB Suerdieck, V Kreuzer and J Liebenthron in Lupus</p

A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity

Background: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. Main body: We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response. Conclusion: In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory authorities and professional leaders to take robust political and regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune system

A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity

Background: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. Main body: We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response. Conclusion: In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory authorities and professional leaders to take robust political and regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune system