Prevention and management of osteoporotic fractures by non-physician health professionals: a systematic literature review to inform EULAR points to consider

Objective To perform a systematic literature review (SLR) about the effect of non-pharmacological interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Methods Eight clinical questions based on two criteria guided the SLR: (1) adults >= 50 years at high risk of osteoporotic fracture and (2) interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Interventions focused on diagnostic procedures to identify risk of falling, therapeutic approaches and implementation strategies. Outcomes included fractures, falls, risk of falling and change in bone mineral density. Systematic reviews and randomised controlled trials were preferentially selected. Data were synthesised using a qualitative descriptive approach. Results Of 15 917 records, 43 articles were included. Studies were clinically and methodologically diverse. We identified sufficient evidence that structured exercise, incorporating progressive resistance training delivered to people who had undergone hip fracture surgery, and multicomponent exercise, delivered to people at risk of primary fracture, reduced risk of falling. The effectiveness of multidisciplinary fracture liaison services in reducing refracture rate was confirmed. There was insufficient evidence found to support the effectiveness of nutrients and falls prevention programmes in this patient population. Conclusion Despite study heterogeneity, our SLR showed beneficial effects of some interventions delivered by non-physician health professionals and the positive impact of multidisciplinary team working and patient educational approaches to prevent and manage osteoporotic fractures. These results informed a EULAR taskforce that developed points to consider for non-physician health professionals to prevent and manage osteoporotic fractures.This study was funded by the EULAR. Grant reference HPR 032.info:eu-repo/semantics/publishedVersio

Final State Interactions and CP Violation in KL→π+π−e+e−K_L \to \pi^+ \pi^- e^+ e^-

Using chiral perturbation theory we calculate the imaginary parts of the $K_L \rightarrow \pi^+ \pi^- e^+ e^-$ form factors that arise from $\pi \pi \rightarrow \pi^+ \pi^-$ and $\pi \pi \rightarrow \pi^+ \pi^- \gamma^*$ rescattering. We discuss their influence on CP violating variables in $K_L \rightarrow \pi^+ \pi^- e^+ e^-$.Comment: ; 12 pages, 2 figures, TeX format; uses epsf.tex, tables.tex, and phyzzx.te

Heterologous expression screens in Nicotiana benthamiana identify a candidate effector of the wheat Yellow Rust Pathogen that associates with processing bodies

Rust fungal pathogens of wheat (Triticum spp.) affect crop yields worldwide. The molecular mechanisms underlying the virulence of these pathogens remain elusive, due to the limited availability of suitable molecular genetic research tools. Notably, the inability to perform high-throughput analyses of candidate virulence proteins (also known as effectors) impairs progress. We previously established a pipeline for the fast-forward screens of rust fungal candidate effectors in the model plant Nicotiana benthamiana. This pipeline involves selecting candidate effectors in silico and performing cell biology and protein-protein interaction assays in planta to gain insight into the putative functions of candidate effectors. In this study, we used this pipeline to identify and characterize sixteen candidate effectors from the wheat yellow rust fungal pathogen Puccinia striiformis f sp tritici. Nine candidate effectors targeted a specific plant subcellular compartment or protein complex, providing valuable information on their putative functions in plant cells. One candidate effector, PST02549, accumulated in processing bodies (P-bodies), protein complexes involved in mRNA decapping, degradation, and storage. PST02549 also associates with the P-body-resident ENHANCER OF mRNA DECAPPING PROTEIN 4 (EDC4) from N. benthamiana and wheat. We propose that P-bodies are a novel plant cell compartment targeted by pathogen effectors

Coping, depression, anxiety, self-efficacy and social support: Impact on adjustment to chronic pain.

Pain is a multidimensional, unique, and private experience. Contemporary biopsychosocial models of chronic pain hypothesize a key role for psychosocial factors as contributing to the experience of and adjustment to chronic pain. The psychosocial factors that have been most often examined as they relate to chronic pain include coping responses, attributions (such as self-efficacy), mood (including depression and anxiety), and social support. Knowledge concerning the relative importance of each of these factors to adjustment is necessary for understanding and developing effective psychosocial interventions. This article reviews the literature concerning the associations between psychosocial factors and adjustment to chronic pain, with a focus on coping, attributions, mood, and social support. Overall, the findings of this research are consistent with biopsychosocial models of chronic pain, and support continued research to help identify the causal relationships among key psychosocial variables and adjustment.El dolor es una experiencia multidimensional, única, y privada. Los modelos biopsicosociales contemporáneos de dolor crónico hipotetizan que los factores psicosociales ejercen un papel clave tanto en la configuración de la experiencia de dolor crónico como en el proceso de ajuste de quien lo sufre. Los factores psicosociales más estudiados incluyen: el afrontamiento, las atribuciones (como la autoeficacia), el estado afectivo (tanto la depresión como la ansiedad) y el apoyo social. Conocer la importancia relativa de cada uno de éstos en los procesos de ajuste a la experiencia del dolor crónico es necesario para entender y desarrollar intervenciones psicosociales eficaces. Este artículo revisa la literatura sobre la relación entre factores psicosociales y procesos de ajuste al dolor crónico, especialmente afrontamiento, atribuciones, estado de ánimo, y apoyo social. En general, las conclusiones de este trabajo son compatibles con los modelos biopsicosociales de dolor crónico, y sugieren continuar las investigaciones para identificar las relaciones causales entre ciertas variables psicosociales y el ajuste al dolor crónico

Association between psychosocial factors and pain intensity, physical functioning, and psychological functioning in patients with chronic pain: A cross-cultural comparison.

Objective. Current models of chronic pain recognize that psychosocial factors influence pain and the effects of pain on daily life. The role of such factors has been widely studied in English speaking individuals with chronic pain. It is possible that the associations of between such factors and adjustment may be influenced by culture. This study sought to evaluate the importance of coping responses, self-efficacy beliefs, and social support to adjustment to chronic pain in a sample of Portuguese patients, and discuss the findings with respect to their similarities and differences from findings of studies with English speaking samples. Method. Measures of pain intensity and interference, physical and psychological functioning, coping responses, self-efficacy, and satisfaction with social support where administered to a sample of 324 Portuguese patients with chronic musculoskeletal pain. Univariate and Multivariate analysis were computed. Findings are interpreted with respect to those from similar studies using English speaking samples. Results. Coping responses and perceived social support were significantly associated with pain interference and both physical and psychological functioning; self-efficacy beliefs were significantly associated with all criterion variables. All coping responses, except for task persistence, were associated positively with pain interference and negatively associated with physical and psychological functioning, with the strongest associations found for catastrophizing, praying/hoping, guarding, resting, asking for assistance and relaxation. Discussion. The findings provide support for the importance of the psychosocial factors studied in adjustment to chronic pain in Portuguese patients, and also suggest the possibility of some differences in the role of these factors due to culture

Psychometric properties of the portuguese version of the pain self-efficacy questionnaire.

Aims: This study sought to translate and evaluate the psychometric properties of a European Portuguese version of the Pain Self-Efficacy Questionnaire (P-PSEQ), in order to enable its use in clinical and cross-cultural studies. Material and Methods: The Pain Self-Efficacy Questionnaire was translated into European Portuguese and then back-translated into English. A consensus version of the translated version was pre-tested with a pilot sample, followed by cognitive debriefing, resulting in a final version of the measure. A convenience sample of 174 Portuguese adults with chronic musculoskeletal pain completed the Portuguese Pain Self-Efficacy Questionnaire (P-PSEQ) and criterion measures of pain intensity (Numerical Ratings Scale), pain interference (Portuguese Brief Pain Inventory Interference Scale), quality of life and general health (SF-12), and psychological functioning (Hospital Anxiety and Depression Scale). Cronbach’s alpha and composite reliability coefficients were computed as measures of reliability, and confirmatory factor analysis was performed. Pearson correlation coefficients between the P-PSEQ score and the criterion measures were computed to evaluate the construct validity of the scale. Results: The P-PSEQ demonstrated good to excellent reliability (Cronbach’s alpha = 0.88 and Composite reliability = 0.92), and showed moderately strong associations with the criterion measures in the hypothesized directions, supporting its cons - truct validity. Additionally, the confirmatory factor analysis supported a single factor solution, as hypothesized. Conclusions: The findings provide strong support for the reliability and validity of the P-PSEQ. Research is needed to determine the responsivity of the P-PSEQ and to establish the generalizability of the results in other samples of Portuguese patients with chronic pain

Contribución adicional para la validación de la versión portuguesa de la escala de interferencia del inventario breve de dolor.

Chronic pain is a significant health problem which interferes with patients daily functioning and quality of life. Valid and reliable measures of pain-related interference are needed to provide adequate care to patients and monitor changes in pain and functioning over time. This study sought to evaluate the reliability and validity of a Portuguese version of the Brief Pain Inventory (P-BPI) interference scale. Two hundred and fourteen patients with chronic musculoskeletal pain completed the P-BPI, 0-10 NRS of pain intensity, Short Form-12 Health Status Questionnaire (SF-12), Hospital Anxiety and Depression Scale (HADS). The P-BPI demonstrated excellent internal consistency (Cronbach’s alpha = .91) and showed moderate associations with the criterion measures (all rs .30 or larger), supporting its construct validity. Confirmatory factor analysis of the P-BPI items yielded a single factor, further supporting its construct validity. The results provide strong support for the reliability and validity of the P-BPI interference scale.Resumen: El dolor crónico es un importante problema de salud que afecta al funcionamiento diario de la persona con dolor, a su bienestar psicológico y a la calidad de vida. Con el fin de prestar cuidados sanitarios adecuados, a monitorear los cambios en el dolor y en el funcionamiento y en vista a la investigación transcultural, se necessitan instrumentos válidos y fiables de evaluación de la interferencia del dolor. El objetivo de este estudio es evaluar la fiabilidad y validez de la versión portuguesa de la Escala de Interferencia de lo Brief Pain Inventory (P-BPI). Doscientos catorze participantes con dolor crónico músculoesquelético respondieron al P-BPI, al 0-10 NRS, al Short Form-12 Health Status Questionnaire (SF-12) y al Hospital Anxiety and Depression Scale (HADS). El P-BPI mostró una excelente consistencia interna (alfa de Cronbach = 0.91) y correlaciones moderadas con las medidas de critério (rs ≥ 0.30). El análisis factorial confirmatorio apoyó la solución de un factor. Los resultados apoyan la fiabilidad y validez de construto de la Escala de Interferencia del P-BPI. Es necesario que futuras investigaciónes evaluen la responsividad de la escala a los cambios en la interferencia del dolor a lo largo del tiempo

Design and Baseline Characteristics of Participants in the Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) Trial of Dulaglutide's Cardiovascular Effects

DigitalThe aim was to determine the effects of dulaglutide, a synthetic once-weekly, injectable human glucagon-like peptide 1 analogue that lowers blood glucose, body weight, appetite and blood pressure, on cardiovascular outcomes. People with type 2 diabetes, aged ≥50 years, with glycated haemoglobin (HbA1c) ≤9.5%, and either a previous cardiovascular event, evidence of cardiovascular disease or ≥2 cardiovascular risk factors were randomly allocated to a weekly subcutaneous injection of either dulaglutide (1.5 mg) or placebo and followed within the ongoing Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) trial every 3 to 6 months. The primary cardiovascular outcome is the first occurrence of the composite of cardiovascular death or non-fatal myocardial infarction or non-fatal stroke. Secondary outcomes include each component of the primary composite cardiovascular outcome, a composite clinical microvascular outcome comprising retinal or renal disease, hospitalization for unstable angina, heart failure requiring hospitalization or an urgent heart failure visit, and all-cause mortality. Follow-up will continue until the accrual of 1200 confirmed primary outcomes. Recruitment of 9901 participants (mean age 66 years, 46% women) occurred in 370 sites located in 24 countries over a period of 2 years. The mean duration of diabetes was 10 years, mean baseline HbA1c was 7.3%, and 31% had prior cardiovascular disease. The REWIND trial's international scope, high proportion of women, high proportion of people without prior cardiovascular disease and inclusion of participants whose mean baseline HbA1c was 7.3% suggests that its cardiovascular and safety findings will be directly relevant to the typical middle-aged patient seen in general practice throughout the world.Ciencias Médicas y de la Salu

The role of spirituality in pain, function, and coping in Individuals with chronic pain

Chronic pain is a multidimensional experience associated with psychosocial (e.g., pain-related beliefs and pain coping responses) and spiritual factors. Spirituality is a universal aspect of the human experience that has been hypothesized to impact pain experience via its effects on pain, physical/psychological function, resilience and pain-related beliefs, and pain coping responses. However, research evaluating the associations between measures of spirituality and measures of pain and function in individuals with chronic pain is limited. This study seeks to address this limitation.info:eu-repo/semantics/publishedVersio

Pain diagnosis, pain coping, and function in individuals with chronic musculoskeletal pain

Purpose: Research supports a role for coping responses in adjustment to chronic pain. However, it is likely that some coping responses play a larger role in adjustment to pain for some individuals than others. The identification of the factors that moderate the association between coping responses and pain-related outcomes has important clinical implications. This study sought to determine if musculoskeletal pain diagnosis moderates the associations between eight pain-coping responses and both pain and function. Patients and Methods: A non-probabilistic sample of 323 persons with different chronic musculoskeletal pain conditions completed measures of pain intensity, physical function, psychological function, and pain-coping responses. Results: With only one exception, the frequency of use of pain-coping responses was not associated with pain diagnosis. Statistically significant moderation effects of pain diagnosis on the association between coping and pain outcomes were found for two coping responses: 1) support seeking when predicting pain intensity, and 2) resting when predicting both physical and psychological function. Conclusion: The findings indicate that coping responses tend to play a similar role in patients' pain and function across different musculoskeletal pain conditions, with some important exceptions. If the findings are found to replicate in other samples, they would have important implications for determining when psychosocial pain treatments might (and when they might not) need to be adapted for specific diagnostic groups.Fundação para a Ciência e Tecnologia - FCTinfo:eu-repo/semantics/publishedVersio